Provider Demographics
NPI:1316096647
Name:STANDARD MEDICAL CLINIC, PA
Entity type:Organization
Organization Name:STANDARD MEDICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:OLFINDO
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-727-2808
Mailing Address - Street 1:PO BOX 4580
Mailing Address - Street 2:MSC 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4580
Mailing Address - Country:US
Mailing Address - Phone:409-727-2808
Mailing Address - Fax:
Practice Address - Street 1:8333 9TH AVE.,
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8151
Practice Address - Country:US
Practice Address - Phone:409-727-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00358YOtherMEDICARE GROUP PTAN
TXK0026OtherSTATE LICENSE
TX8937M0OtherBCBS PROV NO.
TX172115101Medicaid
TXK0026OtherSTATE LICENSE