Provider Demographics
NPI:1659611952
Name:S.T.C. MEDICUS ENTERPRISES, LLC
Entity Type:Organization
Organization Name:S.T.C. MEDICUS ENTERPRISES, LLC
Other - Org Name:MOMENTUM HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:409-291-8880
Mailing Address - Street 1:4347 PHELAN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2159
Mailing Address - Country:US
Mailing Address - Phone:409-291-8880
Mailing Address - Fax:409-291-8829
Practice Address - Street 1:4347 PHELAN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2159
Practice Address - Country:US
Practice Address - Phone:409-291-8880
Practice Address - Fax:409-291-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health