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General NPI Number Information
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NPI Number | 1780151498
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Entity Type | Organization
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Legal Business Name | SOUTHWIND SERVICES LLC
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 1015 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-2513
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Country | US
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Telephone | 573-944-3604
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 LEELAND ST
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City | HOUSTON
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State | TX
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Zip | 77023-3012
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Country | US
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Telephone | 573-944-3604
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA EVANS
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Credential |
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Telephone | 573-944-3604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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