| Organization Name: | SPACE CENTER IPA PA |
| NPI Number: | 1891900981 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOE E POUZAR (PRESIDENT) |
| Mailing Address: | 12902 Cloud Dr Santa Fe |
| State: | TX US |
| Postal Code: | 775109345 |
| Phone Number: | 4093161928 |
| Fax Number: | 7133449421 |
| NPI Enumeration Date: | 05/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |