Healthcare Provider Details

I. General information

NPI: 1376129932
Provider Name (Legal Business Name): MID COAST MEDICAL CENTER-CENTRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W WALLACE ST
SAN SABA TX
76877-4434
US

IV. Provider business mailing address

305 SANDY CORNER RD
EL CAMPO TX
77437-9535
US

V. Phone/Fax

Practice location:
  • Phone: 979-543-5510
  • Fax:
Mailing address:
  • Phone: 979-543-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID H MAK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 713-569-7370