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Organization
SAN AUGUSTINE FAMILY PRACTICE PA
Active
Organization
SAN AUGUSTINE FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE DEANN ANDERSON (BILLING & COLLECTIONS)
(936) 275-9910
Entity
Organization
Contact information
Practice address
200 E LIVINGSTON ST, SAN AUGUSTINE, TX 75972-2028
(936) 275-9910
(936) 275-9710
Mailing address
200 E LIVINGSTON ST, SAN AUGUSTINE, TX 75972-2028
(936) 275-9910
(936) 275-9710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K1721
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0084KU
BLUE CROSS BLUE SHIELD
TX
01
—
8K5535
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/08/2006
Last updated
11/08/2007
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