Provider Demographics
NPI:1396305413
Name:STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Entity type:Organization
Organization Name:STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-824-1480
Mailing Address - Street 1:905 N GULF BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-3907
Mailing Address - Country:US
Mailing Address - Phone:281-824-1480
Mailing Address - Fax:281-222-6407
Practice Address - Street 1:905 N GULF BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-3907
Practice Address - Country:US
Practice Address - Phone:281-824-1480
Practice Address - Fax:281-222-6407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-20
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy