Healthcare Provider Details

I. General information

NPI: 1184014433
Provider Name (Legal Business Name): SRP OCEANS HOSPITAL OF SAN MARCOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N IH 35
SAN MARCOS TX
78666-7030
US

IV. Provider business mailing address

8343 DOUGLAS AVE STE 350
DALLAS TX
75225-5887
US

V. Phone/Fax

Practice location:
  • Phone: 512-353-0194
  • Fax: 512-353-0196
Mailing address:
  • Phone: 512-353-0194
  • Fax: 512-667-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number100313
License Number StateTX

VIII. Authorized Official

Name: SCOTT WILSON
Title or Position: PRESIDENT
Credential:
Phone: 214-635-4748