Provider Demographics
NPI:1114077427
Name:SOUTH TEXAS MEDICAL CLINICS, P.A.
Entity Type:Organization
Organization Name:SOUTH TEXAS MEDICAL CLINICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:979-532-1700
Mailing Address - Street 1:508 OTTO ST.
Mailing Address - Street 2:
Mailing Address - City:EAST BERNARD
Mailing Address - State:TX
Mailing Address - Zip Code:77435
Mailing Address - Country:US
Mailing Address - Phone:979-335-7578
Mailing Address - Fax:979-335-4466
Practice Address - Street 1:508 OTTO ST.
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435
Practice Address - Country:US
Practice Address - Phone:979-335-7578
Practice Address - Fax:979-335-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty