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NPI Code Detail

MEDICARE: JACINTO MEDICAL GROUP P A

MEDICARE: JACINTO MEDICAL GROUP P A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician816738-03TX
2207R00000XInternal Medicine Physician816738-03TX
3207Q00000XFamily Medicine Physician816738-03TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100U80BOTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265474597
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACINTO MEDICAL GROUP P A
Provider Business Mailing Address
First Line : 2800 GARTH RD
Second Line :
City : BAYTOWN
State : TX
Zip : 77521-3947
Country : US
Telephone Number : 281-425-3800
Fax Number : 281-425-3992
Provider Business Practice Location Address
First Line : 2800 GARTH RD
Second Line :
City : BAYTOWN
State : TX
Zip : 77521-3947
Country : US
Telephone Number : 281-425-3800
Fax Number : 281-425-3992
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : MRS. MAGGIE KHAN
Credential :
Telephone Number : 281-425-3844
Provider Enumeration Date : 06/12/2006
Last Update Date : 02/13/2012

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Directions to “JACINTO MEDICAL GROUP P A ” Practice Location

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