Provider Demographics
NPI:1609383660
Name:AMELIA SOUTHWEST HEALTH
Entity Type:Organization
Organization Name:AMELIA SOUTHWEST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-633-2388
Mailing Address - Street 1:211 OAK HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3115
Mailing Address - Country:US
Mailing Address - Phone:512-633-2388
Mailing Address - Fax:512-233-5934
Practice Address - Street 1:5903 LONG CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-4920
Practice Address - Country:US
Practice Address - Phone:512-633-2388
Practice Address - Fax:512-233-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty