Provider Demographics
NPI:1053963009
Name:ST. JOSEPH REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:ST. JOSEPH REGIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:THERON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-2599
Mailing Address - Street 1:2801 FRANCISCAN DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2544
Mailing Address - Country:US
Mailing Address - Phone:979-776-2478
Mailing Address - Fax:
Practice Address - Street 1:1604 ROCK PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8345
Practice Address - Country:US
Practice Address - Phone:979-764-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital