=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154361475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SJ MEDICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 ST JOSEPH PKWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77002-8301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-757-1000
-----------------------------------------------------
Fax | 713-657-7123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 N PEARL ST STE 2400 ATTN: LEGAL DEPARTMENT
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-2470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-341-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOSPITAL PRESIDENT
-----------------------------------------------------
Name | KIMBERLY S BASSETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-757-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 000015
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------