Provider Demographics
NPI:1770688905
Name:SOUTH TEXAS MEDICAL CLINICS, P.A.
Entity Type:Organization
Organization Name:SOUTH TEXAS MEDICAL CLINICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-532-6701
Mailing Address - Street 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-4584
Practice Address - Street 1:2100 REGIONAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-9719
Practice Address - Country:US
Practice Address - Phone:979-532-1700
Practice Address - Fax:979-532-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2422208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L423OtherBCBS OF TEXAS
TX138702903Medicaid
TXCO9161OtherRAILROAD GBA - RAILROAD MEDICARE
TX=========OtherTAX ID #
TX0434730003Medicare NSC
TX=========OtherTAX ID #