Provider Demographics
NPI:1205821345
Name:SOUTH TEXAS HEALTH CARE SYSTEM
Entity type:Organization
Organization Name:SOUTH TEXAS HEALTH CARE SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-KEEBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-364-8401
Mailing Address - Street 1:1401 S RANGERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-7638
Mailing Address - Country:US
Mailing Address - Phone:956-364-8741
Mailing Address - Fax:956-425-2692
Practice Address - Street 1:1401 S RANGERVILLE RD
Practice Address - Street 2:OPC PHARMACY - BLDG 504
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-7638
Practice Address - Country:US
Practice Address - Phone:956-364-8741
Practice Address - Fax:956-425-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX019599333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX800000Medicaid