MEDICARE: SOUTHWEST TEXAS MEDICAL SERVICE

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	207L00000X	Anesthesiology Physician	K4261	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

General Provider Information

NPI Number	:	1689841934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST TEXAS MEDICAL SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 91159
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77291-1159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 LA BRANCH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4822
Country	:	US
Telephone Number	:	713-691-7744
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADETOLA TALABI
Credential	:	M.D.
Telephone Number	:	832-607-6331

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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Directions to “SOUTHWEST TEXAS MEDICAL SERVICE ” Practice Location

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