Basic Information
| Provider Information | |||||||||
| NPI: | 1396305413 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 905 N GULF BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FREEPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775413907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
| FaxNumber: | 2812226407 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 N GULF BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FREEPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775413907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
| FaxNumber: | 2812226407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 01/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | BRANDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 2818241480 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC | ||||||||
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| NPICertificationDate: | 01/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.