Basic Information
| Provider Information | |||||||||
| NPI: | 1891789772 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAN JACINTO METHODIST HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOUSTON METHODIST BAYTOWN HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4755 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772104755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325227574 | ||||||||
| FaxNumber: | 8326675903 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 GARTH RD | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775212122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814208600 | ||||||||
| FaxNumber: | 2814208852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BERNARD | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2814208600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 000405 | TX | Y | Hospitals | General Acute Care Hospital |
No ID Information.