Stephen F Austin Community Health Center,Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

STEPHEN F AUSTIN COMMUNITY HEALTH CENTER,INC

Doing business as

Galveston Integrated Health Clinic

Practice address

123 Rosenberg St
4TH Floor
Galveston, TX 77550-1494

Phone

(281) 824-1480

Fax

(281) 220-6407

NPI assigned

Oct 28, 2016

Last updated

Jan 22, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Young

Title

Ceo

Phone

(281) 824-1480

Specialties & licenses 1

Addresses

Other names 1

• Galveston Integrated Health Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336691096. Details of each certification follow.

• CCN 741975 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 741975

Legal name

GALVESTON INTEGRATED HEALTH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 3, 2017

Last certification

Nov 3, 2017

Ownership / control type

For profit – corporation

Facility address

123 Rosenberg St, 4TH Floor
Galveston, TX 77550

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642809600000",
    "number": "1336691096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W ADOUE ST",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775112718",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 ROSENBERG ST",
            "address_2": "4TH FLOOR",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775501494",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F AUSTIN COMMUNITY HEALTH CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2022-01-22",
        "certification_date": "2022-01-22",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "281-824-1480",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galveston Integrated Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Michael Starkey, MD
• State of Mind Psychiatry & Wellness
• Kimberly Joy Staton, FNP
• Kathleen Georgette Stauffer, CNM
• Rachel Stepanek, MD
• Catherine A Stephens, LPC
• Claude Patrick Stephens, PTA
• Michael Shane Stephens, MD
• Kelly W Stephenson, M.D.
• Samuel David Stephenson, MD

• Federally Qualified Health Center (FQHC) in Galveston, TX
• Providers in Galveston, TX by specialty
• Federally Qualified Health Center (FQHC) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.