HEALTH CENTER OF SOUTHEAST TEXAS (NPI# 1043570567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043570567 |
| Entity Type | Organization |
| Organization Name | HEALTH CENTER OF SOUTHEAST TEXAS |
| Other Organization Name | HEALTH CENTER OF SOUTHEAST TEXAS - LIBERTY |
| Practice Address |
1202 N Travis St Liberty TX 77575-3540 |
| Mailing Address |
307 N William Barnett Ave Cleveland TX 77327-4061 |
| Practice Telephone | 9363341185 |
| Practice Fax Number | 9363913000 |
| Mailing Telephone | 2815922224 |
| Mailing Fax Number | 2815922225 |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | MR. STEVEN RACCIATO (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2815922224 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | MEDICARE GROUP NUMBER | 00W245 | 01 |
| TX | 179566802 | 05 | |
| TX | BLUE CROSS/SHIELD GROUP NUMBER | 0044NH | 01 |
| TX | 179566801 | 05 | |
| TX | 179566803 | 05 |
| Other Name | Type Code |
|---|---|
| Health Center of Southeast Texas - Liberty | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316595838 | Health Center of Southeast Texas | Family Medicine | 1002 Bowie St, Liberty, TX 77575-4659 | 2019-08-28 |
| 1346472537 | Health Center of Southeast Texas | Clinic/Center | 1651 S Byrd Ave, Shepherd, TX 77371-3281 | 2009-08-20 |
| 1225059686 | Health Center of Southeast Texas | Clinic/Center | 307 N William Barnett Ave, Cleveland, TX 77327-4061 | 2006-07-21 |
| 1124640347 | Health Center of Southeast Texas | Pharmacy | 307 N William Barnett Ave, Cleveland, TX 77327-4061 | 2020-05-11 |
| 1659744217 | Health Center of Southeast Texas | Clinic/Center | 307 N William Barnett Ave, Cleveland, TX 77327-4061 | 2015-11-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | HEALTH CENTER OF SOUTHEAST TEXAS | 307 N William Barnett Ave, Cleveland, TX 77327-4061 |
| Street Address |
1202 N TRAVIS ST |
| City | LIBERTY |
| State | TX |
| Zip Code | 77575-3540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750981502 | Parikshit Jayant Davda | Clinic/Center | 1620 Magbolia Street, Liberty, TX 77575 | 2020-10-30 |
| 1003285156 | Divine Garden Transportation | Non-emergency Medical Transport (VAN) | 450 Mlking Dr., Liberty, TX 77575 | 2015-09-18 |
| 1689895799 | Allen R. Griffin | Eyewear Supplier (Equipment, not the service) | 2718 B N. Main St., Liberty, TX 77575 | 2007-05-02 |
| 1548362395 | Hsmtx/liberty, LLC | Skilled Nursing Facility | 1206 N Travis St, Liberty, TX 77575 | 2006-09-02 |
| 1699877530 | Lessie Frank | Licensed Vocational Nurse | 612 Highway 90, Liberty, TX 77575 | 2006-09-01 |
| 1588601827 | Trudy Poor Britz | Nurse Practitioner | 1807 Rampart, League, TX 77575 | 2006-06-02 |
| 1285680033 | Faresh Mehta | Optometrist | 2121 Hwy 146 Bypass, Liberty, TX 77575 | 2006-05-25 |
| 1922455781 | Bassam A. Hamid M.d.,p.a. Urgent Care/primarycare | Clinic/Center | 608 Travis, Liberty, TX 77575 | 2016-05-20 |
| 1508887241 | Tri-county Behavioral Healthcare | Intermediate Care Facility, Mentally Retarded | 1420 Holly St, Liberty, TX 77575-3118 | 2006-07-21 |
| 1528581220 | D&s Residential Services, Lp | Intermediate Care Facility, Mentally Retarded | 1420 Holly St, Liberty, TX 77575-3118 | 2017-07-25 |
| Find all providers in zip 77575 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356723951 | Cumberland Family Medical Center, Inc. | Clinic/Center | 2834 S Us 127, Liberty, KY 42539-8350 | 2015-06-19 |
| 1982931655 | Samuel U. Rodgers Health Center, Inc. | Clinic/Center | 800 Haines Drive, Liberty, MO 64068 | 2009-11-17 |
| 1720460868 | Cumberland Family Medical Center, Inc. | Clinic/Center | 6295 E Ky 70, Liberty, KY 42539-6762 | 2015-06-25 |
| 1437531035 | Cumberland Family Medical Center, Inc. | Clinic/Center | 1841 E Ky 70, Liberty, KY 42539-6718 | 2015-06-19 |
| 1881076487 | Cumberland Family Medical Center, Inc. | Clinic/Center | 1673 E Ky 70, Liberty, KY 42539-6716 | 2015-06-19 |
| 1639551237 | Cumberland Family Medical Center, Inc. | Clinic/Center | 75 College St, Liberty, KY 42539-3271 | 2015-06-19 |
| 1902228075 | Cumberland Family Medical Center Inc | Clinic/Center | 376 Randolph St, Liberty, KY 42539-3382 | 2014-01-09 |
| 1659693083 | Amite County Medical Services, Inc. | Clinic/Center | 102 West Freedom Drive, Liberty, MS 39645 | 2010-02-26 |
| 1073634226 | Amite County Medical Services, Inc. | Clinic/Center | 102 West Freedom Drive, Liberty, MS 39645-0511 | 2007-04-03 |
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|---|---|---|---|---|
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| 1366043689 | Legacy Community Health Services, Inc. | Clinic/Center | 1900 Strawn Rd., Houston, TX 77039-2017 | 2020-11-03 |
| 1275134595 | Legacy Community Health Services, Inc | Clinic/Center | 507 Crenshaw Rd., Houston, TX 77034-1543 | 2020-11-03 |
| 1912508235 | Legacy Community Health Services, Inc | Clinic/Center | 120 Westheimer Rd., Suite F, Houston, TX 77006-3332 | 2020-11-03 |
| 1720688534 | Barrio Comprehensive Family Health Care Center, Inc. | Clinic/Center | 11930 Us Highway 90, Suite 110, San Antonio, TX 78252 | 2020-10-30 |
| 1053918516 | Legacy Community Health Services, Inc. | Clinic/Center | 13703 Aldine Westfield Rd, Houston, TX 77039-2001 | 2020-10-07 |
| 1205449386 | Matagorda Episcopal Health Outreach Program | Clinic/Center | 2112 Regional Medical Drive Suite 1305, Wharton, TX 77488 | 2020-08-28 |
| 1568075638 | Matagorda Episcopal Health Outreach Program | Clinic/Center | 2112 Regional Medical Center, Suite 1317, Wharton, TX 77488-9719 | 2020-08-28 |
| 1144831835 | Matagorda Episcopal Health Outreach Program | Clinic/Center | 2112 Regional Medical Center Drive Suite 1315, Wharton, TX 77488-9719 | 2020-08-14 |
| 1780295741 | East Texas Border Health Clinic | Clinic/Center | 705 S Grove St, Marshall, TX 75670-5220 | 2020-08-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.