Provider Demographics
NPI:1790835114
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:CREDENTIALER
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:CREDENTIALER
Authorized Official - Phone:979-532-1700
Mailing Address - Street 1:1700 GOLDEN AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3189
Mailing Address - Country:US
Mailing Address - Phone:979-245-3690
Mailing Address - Fax:979-245-8085
Practice Address - Street 1:1700 GOLDEN AVE STE 1001
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3189
Practice Address - Country:US
Practice Address - Phone:979-245-3690
Practice Address - Fax:979-245-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty