Provider Demographics
NPI:1619288545
Name:SAN JACINTO METHODIST HOSPITAL
Entity Type:Organization
Organization Name:SAN JACINTO METHODIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:ADA
Authorized Official - Last Name:NDUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-459-9892
Mailing Address - Street 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:800-816-8197
Mailing Address - Fax:
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3153
Practice Address - Country:US
Practice Address - Phone:800-816-8197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital