=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366186447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEEMOSYNANT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2022
-----------------------------------------------------
Last Update Date | 06/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E VANCE ST
-----------------------------------------------------
City | REFUGIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78377-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-771-8516
-----------------------------------------------------
Fax | 361-349-3027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 POMPANO AVE
-----------------------------------------------------
City | GALVESTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77550-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-771-8516
-----------------------------------------------------
Fax | 409-220-8350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREL CAPEK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 409-771-8516
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------