Provider Demographics
NPI:1609004381
Name:SOS HEALTHCARE CENTER, INC.
Entity type:Organization
Organization Name:SOS HEALTHCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:817-477-9494
Mailing Address - Street 1:304 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:980 N WALNUT CREEK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8019
Practice Address - Country:US
Practice Address - Phone:817-477-5700
Practice Address - Fax:817-477-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty