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General NPI Number Information
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NPI Number | 1184014433
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Entity Type | Organization
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Legal Business Name | SRP OCEANS HOSPITAL OF SAN MARCOS LLC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 1106 N IH 35
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City | SAN MARCOS
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State | TX
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Zip | 78666-7030
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Country | US
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Telephone | 512-353-0194
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Fax | 512-353-0196
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Provider Business Mailing Address
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Address Line | 8343 DOUGLAS AVE STE 350
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City | DALLAS
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State | TX
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Zip | 75225-5887
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Country | US
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Telephone | 512-353-0194
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Fax | 512-667-7840
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT WILSON
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Credential |
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Telephone | 214-635-4748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 100313
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License Number State | TX
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