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General NPI Number Information
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NPI Number | 1467009092
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Entity Type | Organization
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Legal Business Name | MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 307 GREEN AVE STE A
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City | PALACIOS
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State | TX
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Zip | 77465-3213
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Country | US
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Telephone | 979-245-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 101 AVENUE F N
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City | BAY CITY
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State | TX
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Zip | 77414-3167
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Country | US
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Telephone | 979-245-2008
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CELESTE HARRISON
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Credential |
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Telephone | 979-245-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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