Organization
HEALTH CENTER OF SOUTHEAST TEXAS
Active
Other names
Health Center of Southeast Texas - Liberty
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN RACCIATO (EXECUTIVE DIRECTOR)
(281) 592-2224
Entity
Organization
Contact information
Practice address
1400 N TRAVIS ST, LIBERTY, TX 77575-3138
(936) 334-1185
Mailing address
307 N WILLIAM BARNETT AVE, CLEVELAND, TX 77327-4061
(281) 592-2224
(281) 592-2225
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0044NH
BLUE CROSS/SHIELD GROUP NUMBER
TX
01
—
00W245
MEDICARE GROUP NUMBER
TX
05
—
179566801
—
TX
05
—
179566802
—
TX
05
—
179566803
—
TX
Enumeration date
05/17/2012
Last updated
02/21/2024
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