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General NPI Number Information
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NPI Number | 1194908285
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Entity Type | Organization
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Legal Business Name | SOUTHERN URGENT CARE CENTER L.P
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 104 GALLERY CIR STE 114
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3330
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Country | US
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Telephone | 210-481-6060
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Fax | 210-481-6068
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Provider Business Mailing Address
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Address Line | 104 GALLERY CIR STE 114
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3330
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Country | US
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Telephone | 210-481-6060
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Fax | 210-481-6068
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUDHIR R GOGU
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Credential | DO
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Telephone | 210-481-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L0209
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License Number State | TX
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