Healthcare Provider Details

I. General information

NPI: 1255417390
Provider Name (Legal Business Name): ST JOSEPH REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

IV. Provider business mailing address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-5366
  • Fax: 979-776-1552
Mailing address:
  • Phone: 979-776-5366
  • Fax: 979-776-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANA STOCKS
Title or Position: TEAM LEADER BILLING
Credential:
Phone: 979-776-5366