Provider Demographics
NPI:1659852234
Name:ST. ELIZABETH PHYSICIAN GROUP, PLLC
Entity Type:Organization
Organization Name:ST. ELIZABETH PHYSICIAN GROUP, PLLC
Other - Org Name:VITRICS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-482-4535
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-1619
Mailing Address - Country:US
Mailing Address - Phone:713-482-4535
Mailing Address - Fax:713-482-4560
Practice Address - Street 1:676 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539
Practice Address - Country:US
Practice Address - Phone:713-482-4535
Practice Address - Fax:713-482-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty