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General NPI Number Information
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NPI Number | 1407738701
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Entity Type | Organization
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Legal Business Name | STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 100 HIGHWAY 332 W STE 1404
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City | LAKE JACKSON
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State | TX
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Zip | 77566-4016
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Country | US
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Telephone | 281-824-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 W ADOUE ST
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City | ALVIN
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State | TX
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Zip | 77511-2718
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Country | US
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Telephone | 281-824-1480
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MARK D YOUNG
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Credential |
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Telephone | 281-824-1480
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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