Basic Information
| Provider Information | |||||||||
| NPI: | 1679037089 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S&C HEALTHCARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 780188 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782780188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305428566 | ||||||||
| FaxNumber: | 2108022620 | ||||||||
| Practice Location | |||||||||
| Address1: | 11212 TX-151 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305428566 | ||||||||
| FaxNumber: | 2108022620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2019 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | MUDIPALLI | ||||||||
| AuthorizedOfficialFirstName: | VASUDEVA | ||||||||
| AuthorizedOfficialMiddleName: | RANJIT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8305428566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34938001 | 01 | TX | DRIVERS LICENSE | OTHER |