Provider Demographics
NPI:1407887110
Name:SOUTHERN TEXAS PHYSICIANS NETWORK, INC
Entity type:Organization
Organization Name:SOUTHERN TEXAS PHYSICIANS NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-350-3901
Mailing Address - Street 1:100B ALTON GLOOR ROAD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526
Mailing Address - Country:US
Mailing Address - Phone:956-350-3901
Mailing Address - Fax:
Practice Address - Street 1:100B ALTON GLOOR ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-350-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045MDOtherBLUE CROSS BLUE SHIELD OF
TX00269YMedicare ID - Type Unspecified