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Organization
ST MARK'S MEDICAL CENTER
Active
Organization
ST MARK'S MEDICAL CENTER
Active
Other names
St Mark's Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY HARTFIELD (CHIEF CLINICAL OFFICER)
(979) 242-2105
Entity
Organization
Contact information
Practice address
2 SAINT MARKS PL STE 110, LA GRANGE, TX 78945-1255
(979) 242-2387
(979) 242-2206
Mailing address
1 SAINT MARKS PL, LA GRANGE, TX 78945-1250
(979) 242-2104
(979) 242-2204
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083XM
BLUE CROSS
TX
05
—
176692503
—
TX
Enumeration date
04/11/2012
Last updated
08/11/2020
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