Provider Demographics
NPI:1346579695
Name:ST JOSEPH MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:ST JOSEPH MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHENGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-255-2300
Mailing Address - Street 1:7457 HARWIN DR
Mailing Address - Street 2:101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2018
Mailing Address - Country:US
Mailing Address - Phone:832-255-2300
Mailing Address - Fax:713-337-5201
Practice Address - Street 1:7457 HARWIN DR
Practice Address - Street 2:101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2018
Practice Address - Country:US
Practice Address - Phone:832-255-2300
Practice Address - Fax:713-337-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty