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
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
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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