=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710300371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SORS MEDICAL GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2014
-----------------------------------------------------
Last Update Date | 07/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7111 HARWIN DR SUITE # 125B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-623-7347
-----------------------------------------------------
Fax | 832-649-4401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7111 HARWIN DR SUITE # 125B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-623-7347
-----------------------------------------------------
Fax | 832-649-4401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. PAUL TURLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-623-7347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 8211
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------