MEDICARE: SOUTHLAND HEALTHCARE SERVICES INC

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	31013	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2162304	OTHER		PK

General Provider Information

NPI Number	:	1679028393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	5302 CANAL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-2258
Country	:	US
Telephone Number	:	713-514-9494
Fax Number	:	713-514-9495

Provider Business Practice Location Address
First Line	:	5302 CANAL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-2258
Country	:	US
Telephone Number	:	713-514-9494
Fax Number	:	713-514-9495

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	JAMES WALKER
Credential	:
Telephone Number	:	713-514-9494

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	11/16/2016

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Directions to “SOUTHLAND HEALTHCARE SERVICES INC ” Practice Location

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