HEALTH CENTER OF SOUTHEAST TEXAS (NPI# 1346472537) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346472537 |
| Entity Type | Organization |
| Organization Name | HEALTH CENTER OF SOUTHEAST TEXAS |
| Other Organization Name | HEALTH CENTER OF SOUTHEAST TEXAS - SHEPHERD |
| Practice Address |
1651 S Byrd Ave Shepherd TX 77371-3281 |
| Mailing Address |
401 E Crockett St Suite A Cleveland TX 77327-4396 |
| Practice Telephone | 9366281100 |
| Practice Fax Number | 9366281199 |
| Mailing Telephone | 2815922224 |
| Mailing Fax Number | 2515925199 |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | 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 | 179566801 | 05 | |
| TX | 179566802 | 05 | |
| TX | 179566803 | 05 | |
| TX | MEDICARE GROUP NUMBER | 00W245 | 01 |
| TX | BLUE CROSS/SHIELD GROUP NUMBER | 0044NH | 01 |
| Other Name | Type Code |
|---|---|
| Health Center of Southeast Texas - Shepherd | 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 |
| 1043570567 | Health Center of Southeast Texas | Clinic/Center | 1202 N Travis St, Liberty, TX 77575-3540 | 2012-05-17 |
| 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 |
1651 S BYRD AVE |
| City | SHEPHERD |
| State | TX |
| Zip Code | 77371-3281 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477058634 | Reyna Avitia | Nurse Practitioner | 1231 Byrd, Shepherd, TX 77371 | 2018-03-28 |
| 1376629212 | Shepherd Rural Health Clinic Pa | Physician Assistant | 11 Woodland Park Drive, Shepherd, TX 77371 | 2006-10-31 |
| 1871011064 | Eric Demond Green | Driver | 90 Pine St, Shepherd, TX 77371 | 2017-09-07 |
| 1689065062 | Carrie Cronin | Occupational Therapist | 9821 Highway 150, Shepherd, TX 77371-2293 | 2015-02-06 |
| 1033507199 | Betty J Charles | Physical Therapy Assistant | 41 Marie St, Shepherd, TX 77371-2419 | 2014-12-24 |
| 1891133294 | Krishawna Mund Thompson | Nurse Practitioner | 16 N Liberty, Shepherd, TX 77371-2460 | 2013-06-06 |
| 1750855623 | Chelsea Nicole Williams | Registered Nurse | 161 Pine Shadows Dr, Shepherd, TX 77371-2513 | 2019-01-14 |
| 1992267785 | Pnv Creative Care, Inc | Pharmacy | 11011 Highway 150, Shepherd, TX 77371-2839 | 2019-04-02 |
| 1720038987 | Pnv Creative Care Inc. | Pharmacy | 11011 Highway 150, Shepherd, TX 77371-2839 | 2006-05-10 |
| 1790120491 | Atlas Case Management Inc. | Case Management | 3800 Fm 2666 Rd, Shepherd, TX 77371-2919 | 2013-05-08 |
| Find all providers in zip 77371 | ||||
| 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 |
|---|---|---|---|---|
| 1598366718 | East Texas Border Health Clinic | Clinic/Center | 1411 College Dr, Texarkana, TX 75503-3533 | 2020-11-04 |
| 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.