Provider Demographics
NPI:1548344286
Name:ST. JOSEPH REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:ST. JOSEPH REGIONAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT FINANCIAL SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-2426
Mailing Address - Street 1:2800 S TEXAS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:936-396-2806
Mailing Address - Fax:936-396-9000
Practice Address - Street 1:910 HWY 3 WEST
Practice Address - Street 2:
Practice Address - City:NORMANGEE
Practice Address - State:TX
Practice Address - Zip Code:77871
Practice Address - Country:US
Practice Address - Phone:936-396-2806
Practice Address - Fax:936-396-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR04586698Medicaid
TXR04586698Medicaid