Provider Demographics
NPI:1336451046
Name:HOSPICE OF SOUTH TEXAS, INC
Entity Type:Organization
Organization Name:HOSPICE OF SOUTH TEXAS, INC
Other - Org Name:PALLIATIVE CARE CENTER OF SOUTH TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:361-572-4300
Mailing Address - Street 1:605 E LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3933
Mailing Address - Country:US
Mailing Address - Phone:361-572-4300
Mailing Address - Fax:361-570-1147
Practice Address - Street 1:605 E LOCUST AVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3933
Practice Address - Country:US
Practice Address - Phone:361-572-4300
Practice Address - Fax:361-570-1147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF SOUTH TEXAS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8837207RH0002X
TXE6195207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202547001Medicaid
TX32TGOtherBCBS
TX202547001Medicaid