# ST MARK'S MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Mark's Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659638914
- **Authorized official:** TAMMY HARTFIELD (CHIEF CLINICAL OFFICER)
- **Authorized official phone:** (979) 242-2105

## Contact information

- **Practice address:** 2 SAINT MARKS PL STE 110, LA GRANGE, TX 78945-1255
- **Practice address phone:** (979) 242-2387
- **Practice address fax:** (979) 242-2206
- **Mailing address:** 1 SAINT MARKS PL, LA GRANGE, TX 78945-1250
- **Mailing address phone:** (979) 242-2104
- **Mailing address fax:** (979) 242-2204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2012
- **Last updated:** 08/11/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0083XM | BLUE CROSS | TX |
| 05 | — | 176692503 | — | TX |