=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699985200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTPATIENT HOSPITAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 NORTH EXPRESSWAY 83, STE 3
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-504-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 NORTH EXPRESSWAY 83, STE 3
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-504-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | IGOR KOZLIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-504-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 450047
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------