Provider Demographics
NPI:1215192398
Name:ST. JOSEPH REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH REGIONAL HEALTH CENTER
Other - Org Name:ST. JOSEPH BUFFALO FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PFITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-2599
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-0398
Mailing Address - Country:US
Mailing Address - Phone:903-322-2204
Mailing Address - Fax:
Practice Address - Street 1:1686 HIGHWAY 79 WEST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831-0398
Practice Address - Country:US
Practice Address - Phone:903-322-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health