1336691096 NPI number — STEPHEN F AUSTIN COMMUNITY HEALTH CENTER,INC

Table of content: ASHLEY NICOLE GARDONI RDN (NPI 1114702925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336691096 NPI number — STEPHEN F AUSTIN COMMUNITY HEALTH CENTER,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336691096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 W ADOUE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALVIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77511-2718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-824-1480
Provider Business Mailing Address Fax Number:
281-220-6407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 ROSENBERG ST
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77550-1494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-824-1480
Provider Business Practice Location Address Fax Number:
281-220-6407
Provider Enumeration Date:
10/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
281-824-1480

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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