Healthcare Provider Details

I. General information

NPI: 1245583582
Provider Name (Legal Business Name): SOUTH HEALTHCARE MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22815 PARKWALK LN
KATY TX
77494-4451
US

IV. Provider business mailing address

22815 PARKWALK LN
KATY TX
77494-4451
US

V. Phone/Fax

Practice location:
  • Phone: 281-850-5325
  • Fax:
Mailing address:
  • Phone: 281-850-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AVERY OBLEPIAS
Title or Position: CEO
Credential:
Phone: 281-850-5325