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General NPI Number Information
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NPI Number | 1124640347
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Entity Type | Organization
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Legal Business Name | HEALTH CENTER OF SOUTHEAST TEXAS
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 307 N WILLIAM BARNETT AVE
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City | CLEVELAND
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State | TX
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Zip | 77327-4061
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Country | US
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Telephone | 281-592-2224
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Fax | 281-592-2225
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Provider Business Mailing Address
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Address Line | 307 N WILLIAM BARNETT AVE
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City | CLEVELAND
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State | TX
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Zip | 77327-4061
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Country | US
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Telephone | 281-592-2224
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Fax | 281-592-2225
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Authorized Official
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Title or Position | CEO
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Name | STEVEN RACCIATO
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Credential |
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Telephone | 281-592-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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