MEDICARE: SOUTHERN HEALTHCARE SERVICES LLC

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1265017743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	8150 SOUTHWEST FWY UNIT V1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1719
Country	:	US
Telephone Number	:	346-320-2105
Fax Number	:	346-802-2110

Provider Business Practice Location Address
First Line	:	8150 SOUTHWEST FWY UNIT V1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1719
Country	:	US
Telephone Number	:	346-320-2105
Fax Number	:	346-802-2110

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SYED RIZVI
Credential	:
Telephone Number	:	281-712-8033

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	12/22/2022

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Directions to “SOUTHERN HEALTHCARE SERVICES LLC ” Practice Location

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