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General NPI Number Information
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NPI Number | 1609383660
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Entity Type | Organization
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Legal Business Name | AMELIA SOUTHWEST HEALTH
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 5903 LONG CT
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City | AUSTIN
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State | TX
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Zip | 78730-4920
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Country | US
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Telephone | 512-633-2388
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Fax | 512-233-5934
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Provider Business Mailing Address
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Address Line | 211 OAK HOLLOW LN
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City | BUDA
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State | TX
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Zip | 78610-3115
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Country | US
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Telephone | 512-633-2388
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Fax | 512-233-5934
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALICE COLEHOWER
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Credential |
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Telephone | 512-633-2388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | J9904
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License Number State | TX
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