Provider Demographics
NPI:1922453505
Name:CHRISTUS SPOHN FAMILY HEALTH CENTER FREER
Entity Type:Organization
Organization Name:CHRISTUS SPOHN FAMILY HEALTH CENTER FREER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR IM REGIONAL OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-881-3830
Mailing Address - Street 1:10002 ROGERS RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4403
Mailing Address - Country:US
Mailing Address - Phone:210-703-0333
Mailing Address - Fax:210-703-0141
Practice Address - Street 1:10002 ROGERS RUN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4403
Practice Address - Country:US
Practice Address - Phone:210-703-0333
Practice Address - Fax:210-703-0141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTUS SPOHN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health