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General NPI Number Information
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NPI Number | 1619789328
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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 | 01/21/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 215 OAK DR S
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5629
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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 | 1346 BROADWAY ST
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City | PEARLAND
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State | TX
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Zip | 77581-6482
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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 DAVID YOUNG
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Credential | MBA
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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