Provider Demographics
NPI:1073973822
Name:SIGNATURE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:SIGNATURE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-539-8339
Mailing Address - Street 1:7920 SAN FELIPE BLVD
Mailing Address - Street 2:1218
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7920 SAN FELIPE BLVD
Practice Address - Street 2:1218
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7988
Practice Address - Country:US
Practice Address - Phone:804-539-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health