MEDICARE: SOUTHWIND 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1780151498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWIND SERVICES LLC

Provider Business Mailing Address
First Line	:	4000 LEELAND ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3012
Country	:	US
Telephone Number	:	573-944-3604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2513
Country	:	US
Telephone Number	:	573-944-3604
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JESSICA EVANS
Credential	:
Telephone Number	:	573-944-3604

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/31/2018

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