Provider Demographics
NPI:1538334461
Name:SOUTHEAST TEXAS FAMILY HEALTH & WELLNESS CENTER
Entity type:Organization
Organization Name:SOUTHEAST TEXAS FAMILY HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-883-4900
Mailing Address - Street 1:PO BOX 2859
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77631-0000
Mailing Address - Country:US
Mailing Address - Phone:409-883-4900
Mailing Address - Fax:409-883-4913
Practice Address - Street 1:220 STRICKLAND DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4750
Practice Address - Country:US
Practice Address - Phone:409-883-4900
Practice Address - Fax:409-883-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2865261QM2500X, 261QP2300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care