Healthcare Provider Details

I. General information

NPI: 1912057225
Provider Name (Legal Business Name): SOUTH TEXAS MEDICAL CLINICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 SCHOOL ST.
NEEDVILLE TX
77461
US

IV. Provider business mailing address

3006 SCHOOL ST
NEEDVILLE TX
77461
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-4114
  • Fax: 979-793-3114
Mailing address:
  • Phone: 979-793-4114
  • Fax: 979-793-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL S. RICHARD
Title or Position: EXECUTIVE DIRECTOR
Credential: EXECUTIVE DIRECTOR
Phone: 979-532-1700