Provider Demographics
NPI:1558485789
Name:ST. JOHNS PHYSICIAN ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ST. JOHNS PHYSICIAN ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHENG SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:713-988-8860
Mailing Address - Street 1:PO BOX 981095
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-8095
Mailing Address - Country:US
Mailing Address - Phone:713-988-8860
Mailing Address - Fax:713-988-8861
Practice Address - Street 1:3139 W HOLCOMBE BLVD
Practice Address - Street 2:#615
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1505
Practice Address - Country:US
Practice Address - Phone:713-988-8860
Practice Address - Fax:713-988-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3125261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154400901Medicaid
TX00458TMedicare PIN
TXG39553Medicare UPIN