# SOUTH SIDE ENT, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134341316
- **Authorized official:** JODIE R ELLIS (BUSINESS OFFICE COORDINATOR)
- **Authorized official phone:** (713) 355-8600

## Contact information

- **Practice address:** 4120 SOUTHWEST FWY, \#200, HOUSTON, TX 77027
- **Practice address phone:** (713) 355-8600
- **Practice address fax:** (713) 355-8069
- **Mailing address:** PO BOX 1759, DEPT 743, HOUSTON, TX 77251-1759
- **Mailing address phone:** (713) 355-8600
- **Mailing address fax:** (713) 355-8069

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020