Provider Demographics
NPI:1265410435
Name:S.A.O.S., P.L.L.C.
Entity type:Organization
Organization Name:S.A.O.S., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-5100
Mailing Address - Street 1:PO BOX 47052
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-7052
Mailing Address - Country:US
Mailing Address - Phone:210-614-5100
Mailing Address - Fax:210-614-5103
Practice Address - Street 1:225 E SONTERRA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-614-5100
Practice Address - Fax:210-614-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7048559OtherAETNA
TX0091HWOtherBCBS
TX7048559OtherAETNA
TX00680TMedicare ID - Type Unspecified