MEDICARE: ISLAND HEALTH CENTER, 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	261QX0100X	Occupational Medicine Clinic/Center	K6521	TX
2	111NR0400X	Rehabilitation Chiropractor	DC4392	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC4392	OTHER	TX	LICENSE
2	8H8092	OTHER	TX	BLUE CROSS BLUESHIELD
3	1629102231	OTHER	TX	NPI 1
4	8H8091	OTHER	TX	BLUE CROSS BLUE SHIELD
5	K6521	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1932328986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND HEALTH CENTER, P.A.

Provider Business Mailing Address
First Line	:	4623 FORT CROCKETT BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-5962
Country	:	US
Telephone Number	:	409-762-7646
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 FORT CROCKETT BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-5962
Country	:	US
Telephone Number	:	409-762-7646
Fax Number	:	409-762-9223

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	DR. LORI L ANTMAN
Credential	:	D.C.
Telephone Number	:	409-762-7646

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	09/11/2025

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Directions to “ISLAND HEALTH CENTER, P.A. ” Practice Location

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