Provider Demographics
NPI:1447287131
Name:ST MARKS MEDICAL CENTER
Entity type:Organization
Organization Name:ST MARKS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DROZD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-242-2110
Mailing Address - Street 1:ONE ST. MARK'S PLACE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945
Mailing Address - Country:US
Mailing Address - Phone:979-242-2200
Mailing Address - Fax:979-242-2299
Practice Address - Street 1:1 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1250
Practice Address - Country:US
Practice Address - Phone:979-242-2200
Practice Address - Fax:979-242-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008234251K00000X, 261Q00000X, 261QA0005X, 282N00000X
TX506983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W090Medicare ID - Type Unspecified