Provider Demographics
NPI:1831514298
Name:ST JOSEPH REGIONAL HEALTH CTR
Entity type:Organization
Organization Name:ST JOSEPH REGIONAL HEALTH CTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CLINICAL SUPPORT SER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-2580
Mailing Address - Street 1:2601 OSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2516
Mailing Address - Country:US
Mailing Address - Phone:979-690-4801
Mailing Address - Fax:
Practice Address - Street 1:2601 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2516
Practice Address - Country:US
Practice Address - Phone:979-690-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy