MEDICARE: SOUTHWEST DOCTORS PA

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1871592097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST DOCTORS PA

Provider Business Mailing Address
First Line	:	8303 SOUTHWEST FWY
Second Line	:	SUITE 125
City	:	HOUSTON
State	:	TX
Zip	:	77074-1600
Country	:	US
Telephone Number	:	713-522-7002
Fax Number	:	713-528-3351

Provider Business Practice Location Address
First Line	:	8303 SOUTHWEST FWY
Second Line	:	SUITE 125
City	:	HOUSTON
State	:	TX
Zip	:	77074-1600
Country	:	US
Telephone Number	:	713-522-7002
Fax Number	:	713-528-3351

Authorized Official
Title or Position	:	PHYSICIAN SERVICES SUPERVISOR
Name	:	PATRICIA GREMILLION
Credential	:
Telephone Number	:	713-522-7002

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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Directions to “SOUTHWEST DOCTORS PA ” Practice Location

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