MEDICARE: SOUTH TEXAS WELLNESS CENTERS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1851411201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS WELLNESS CENTERS LLC

Provider Business Mailing Address
First Line	:	3003 SOUTH LOOP W STE 415
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1301
Country	:	US
Telephone Number	:	713-839-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 SOUTH LOOP W STE 415
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1301
Country	:	US
Telephone Number	:	713-839-9355
Fax Number	:

Authorized Official
Title or Position	:	D.O.
Name	:	PLESHETTE B JOHNSON
Credential	:	D.O.
Telephone Number	:	713-839-9355

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	03/18/2008

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