Organization
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Active
Parent organization
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Other names
Victory Lakes Family Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Authorized official
BRANDY RENEE SMITH (CREDENTIALING COORDINATOR)
(281) 824-1480
Entity
Organization
Contact information
Practice address
2360 GULF FWY S, STE 100C, LEAGUE CITY, TX 77573-6448
(281) 824-1480
(281) 220-6407
Mailing address
2360 GULF FWY S, STE 100C, LEAGUE CITY, TX 77573-6448
(281) 824-1480
(281) 220-6407
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
399363601
—
TX
01
—
45D2151249
CLIA
TX
Enumeration date
01/04/2018
Last updated
03/26/2024
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