MEDICARE: ST. CHRISTOPHER MEDICAL CLINIC, INC.

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1942298823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. CHRISTOPHER MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1449
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650-1449
Country	:	US
Telephone Number	:	409-684-3232
Fax Number	:	409-684-3535

Provider Business Practice Location Address
First Line	:	1698 HIGHWAY 87
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650
Country	:	US
Telephone Number	:	409-684-3232
Fax Number	:	409-684-3535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DOLLY R DARIA
Credential	:
Telephone Number	:	409-684-3232

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	08/22/2020

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