Provider Demographics
NPI:1083367197
Name:MISSOURI CITY SA SERVICES LLC
Entity Type:Organization
Organization Name:MISSOURI CITY SA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-277-0500
Mailing Address - Street 1:9119 HIGHWAY 6 PO BOX 162
Mailing Address - Street 2:STE 230
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11227 SARDINIA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5100
Practice Address - Country:US
Practice Address - Phone:832-277-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty