Basic Information
| Provider Information | |||||||||
| NPI: | 1104200070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SJS MEDICAL CONSULTING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 182255 | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432182255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144305707 | ||||||||
| FaxNumber: | 6144305744 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SE INNER LOOP | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786267700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128199400 | ||||||||
| FaxNumber: | 5128199404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2015 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | JANKE-STEDRONSKY | ||||||||
| AuthorizedOfficialFirstName: | SHONDA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2283654462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | P3174 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.