MEDICARE: SOUTHERN URGENT CARE CENTER L.P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L0209	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	H19945	OTHER	TX	UPIN

General Provider Information

NPI Number	:	1194908285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN URGENT CARE CENTER L.P

Provider Business Mailing Address
First Line	:	104 GALLERY CIR STE 114
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3330
Country	:	US
Telephone Number	:	210-481-6060
Fax Number	:	210-481-6068

Provider Business Practice Location Address
First Line	:	104 GALLERY CIR STE 114
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3330
Country	:	US
Telephone Number	:	210-481-6060
Fax Number	:	210-481-6068

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SUDHIR R GOGU
Credential	:	DO
Telephone Number	:	210-481-6060

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	06/17/2024

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