Basic Information
| Provider Information | |||||||||
| NPI: | 1053963009 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. JOSEPH REGIONAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 FRANCISCAN DR | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778022544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797762478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1604 ROCK PRAIRIE RD | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778458345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797645100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | PARK | ||||||||
| AuthorizedOfficialFirstName: | THERON | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9797762599 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.