MEDICARE: HEALTH CENTER OF SOUTHEAST TEXAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363LF0000X	Family Nurse Practitioner
3	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	00W245	OTHER	TX	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0044NH	OTHER	TX	BLUE CROSS/SHIELD GROUP NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346472537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CENTER OF SOUTHEAST TEXAS

Provider Business Mailing Address
First Line	:	307 N WILLIAM BARNETT AVE
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4061
Country	:	US
Telephone Number	:	281-592-2224
Fax Number	:	281-592-2225

Provider Business Practice Location Address
First Line	:	11 WOODLAND PARK DR
Second Line	:
City	:	SHEPHERD
State	:	TX
Zip	:	77371-6495
Country	:	US
Telephone Number	:	936-628-1100
Fax Number	:	936-628-1199

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STEVEN RACCIATO
Credential	:
Telephone Number	:	281-592-2224

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	06/21/2023

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Directions to “HEALTH CENTER OF SOUTHEAST TEXAS ” Practice Location

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