MEDICARE: SOUTH TEXAS MEDICAL CLINICS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1114077427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS MEDICAL CLINICS, P.A.

Provider Business Mailing Address
First Line	:	508 OTTO ST.
Second Line	:
City	:	EAST BERNARD
State	:	TX
Zip	:	77435
Country	:	US
Telephone Number	:	979-335-7578
Fax Number	:	979-335-4466

Provider Business Practice Location Address
First Line	:	508 OTTO ST.
Second Line	:
City	:	EAST BERNARD
State	:	TX
Zip	:	77435
Country	:	US
Telephone Number	:	979-335-7578
Fax Number	:	979-335-4466

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAVID CLARK
Credential	:	EXECUTIVE DIRECTOR
Telephone Number	:	979-532-1700

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/22/2020

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