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General NPI Number Information
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NPI Number | 1043379597
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Entity Type | Organization
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Legal Business Name | SAN AUGUSTINE FAMILY PRACTICE PA
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 200 E LIVINGSTON ST
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City | SAN AUGUSTINE
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State | TX
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Zip | 75972-2028
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Country | US
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Telephone | 936-275-9910
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Fax | 936-275-9710
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Provider Business Mailing Address
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Address Line | 200 E LIVINGSTON ST
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City | SAN AUGUSTINE
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State | TX
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Zip | 75972-2028
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Country | US
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Telephone | 936-275-9910
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Fax | 936-275-9710
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Authorized Official
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Title or Position | BILLING & COLLECTIONS
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Name | STEPHANIE DEANN ANDERSON
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Credential |
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Telephone | 936-275-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K1721
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License Number State | TX
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