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General NPI Number Information
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NPI Number | 1083975312
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Entity Type | Organization
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Legal Business Name | SJMC PHYSICIAN SERVICES
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 1401 ST JOSEPH PKWY (ATTN: SJMC PHYSICIAN SERVICES)
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City | HOUSTON
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State | TX
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Zip | 77002-8301
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Country | US
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Telephone | 713-757-1000
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Fax | 713-657-7123
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Provider Business Mailing Address
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Address Line | PO BOX 847747
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City | DALLAS
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State | TX
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Zip | 75284-7747
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Country | US
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Telephone | 866-286-4922
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Fax | 314-432-9683
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN A DEMKE
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Credential |
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Telephone | 615-467-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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