Provider Demographics
NPI:1104245729
Name:ST ELIZABETH FAMILY CARE
Entity type:Organization
Organization Name:ST ELIZABETH FAMILY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-218-7200
Mailing Address - Street 1:676 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3904
Mailing Address - Country:US
Mailing Address - Phone:281-218-7200
Mailing Address - Fax:281-218-7203
Practice Address - Street 1:676 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3904
Practice Address - Country:US
Practice Address - Phone:409-572-4535
Practice Address - Fax:281-218-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service