MEDICARE: ST. JOHNS

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	261Q00000X	Clinic/Center	K3125	TX

General Provider Information

NPI Number	:	1558485615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHNS

Provider Business Mailing Address
First Line	:	PO BOX 981095
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-8095
Country	:	US
Telephone Number	:	713-988-8860
Fax Number	:	713-988-8861

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:	SUITE 1460
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	713-988-8860
Fax Number	:	713-988-8861

Authorized Official
Title or Position	:	MD
Name	:	DR. SAMUEL CHEN
Credential	:	MD, PH. D. MPH
Telephone Number	:	713-988-8860

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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