Provider Demographics
NPI:1699704478
Name:STEVEN A. BRANCH
Entity type:Organization
Organization Name:STEVEN A. BRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:361-552-2999
Mailing Address - Street 1:1202 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2507
Mailing Address - Country:US
Mailing Address - Phone:361-552-2999
Mailing Address - Fax:361-552-1566
Practice Address - Street 1:1202 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2507
Practice Address - Country:US
Practice Address - Phone:361-552-2999
Practice Address - Fax:361-552-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0677860001Medicare NSC