Healthcare Provider Details

I. General information

NPI: 1568075638
Provider Name (Legal Business Name): MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 REGIONAL MEDICAL DR STE 1317
WHARTON TX
77488-1413
US

IV. Provider business mailing address

101 AVENUE F N
BAY CITY TX
77414-3167
US

V. Phone/Fax

Practice location:
  • Phone: 979-245-2008
  • Fax:
Mailing address:
  • Phone: 979-245-2008
  • Fax: 979-314-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CELESTE HARRISON
Title or Position: CEO
Credential:
Phone: 979-245-2008