Provider Demographics
NPI:1790454338
Name:STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-824-1480
Mailing Address - Street 1:1111 W ADOUE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2718
Mailing Address - Country:US
Mailing Address - Phone:281-824-1480
Mailing Address - Fax:281-220-6407
Practice Address - Street 1:1111 W ADOUE ST STE 100
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2718
Practice Address - Country:US
Practice Address - Phone:281-824-1470
Practice Address - Fax:281-643-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33955OtherTSBP