Provider Demographics
NPI:1972874287
Name:S-S-C
Entity type:Organization
Organization Name:S-S-C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-379-7480
Mailing Address - Street 1:779 N TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-3883
Mailing Address - Country:US
Mailing Address - Phone:361-668-0919
Mailing Address - Fax:361-668-0816
Practice Address - Street 1:779 N TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3883
Practice Address - Country:US
Practice Address - Phone:361-668-0919
Practice Address - Fax:361-668-0816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S-S-C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX300671001Medicaid