Healthcare Provider Details

I. General information

NPI: 1134424757
Provider Name (Legal Business Name): PROVIDER SERVICES OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22119 BRIDGESTONE HAWK CT
SPRING TX
77388-4663
US

IV. Provider business mailing address

22119 BRIDGESTONE HAWK CT
SPRING TX
77388-4663
US

V. Phone/Fax

Practice location:
  • Phone: 281-433-9298
  • Fax:
Mailing address:
  • Phone: 281-433-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSITA CHITMAN-ALLEN
Title or Position: CEO
Credential: RN
Phone: 281-433-9298