Provider Demographics
| NPI: | 1669557179 |
|---|---|
| Name: | ST. JOSEPH REGIONAL HEALTH CENTER |
| Entity type: | Organization |
| Organization Name: | ST. JOSEPH REGIONAL HEALTH CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MARKET PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BERNEY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CRANE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 979-776-2599 |
| 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: | 936-266-3513 |
| Mailing Address - Fax: | 936-266-8618 |
| Practice Address - Street 1: | 2801 FRANCISCAN DR |
| Practice Address - Street 2: | |
| Practice Address - City: | BRYAN |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77802-2544 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 979-776-2426 |
| Practice Address - Fax: | 979-776-5948 |
| 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 Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 081951801 | Medicaid | |
| TX | 081951802 | Medicaid |
