Provider Demographics
NPI:1164738142
Name:HIS HOLDINGS GROUP LLC, HIS KIDS AMBULATORY INFUSION CTR
Entity Type:Organization
Organization Name:HIS HOLDINGS GROUP LLC, HIS KIDS AMBULATORY INFUSION CTR
Other - Org Name:H.I.S. KIDS AMBULATORY INFUSION CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIMA
Authorized Official - Middle Name:ONEKIE
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-884-0972
Mailing Address - Street 1:423 TERRA COTTA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-9218
Mailing Address - Country:US
Mailing Address - Phone:210-884-0972
Mailing Address - Fax:
Practice Address - Street 1:812 S. HACKBERRY ST.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203
Practice Address - Country:US
Practice Address - Phone:210-884-0972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy