# SPACE CENTER IPA PA

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

## Provider details

- **NPI number:** 1891900981
- **Authorized official:** JOE E POUZAR MD (PRESIDENT)
- **Authorized official phone:** (409) 316-1928

## Contact information

- **Practice address:** 12902 CLOUD DR, SANTA FE, TX 77510-9345
- **Practice address phone:** (409) 316-1928
- **Practice address fax:** (713) 344-9421
- **Mailing address:** PO BOX 525, SANTA FE, TX 77510-0525
- **Mailing address phone:** (409) 316-1928
- **Mailing address fax:** (713) 344-9421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 08/22/2020