NPIMap

Organization Active NPI

St. Joseph Regional Health Center

Doing business as St. Joseph Family Medicine Holleman

  • Primary Care Clinic/Center
  • College Station, TX
National Provider Identifier
1487099248
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ST. JOSEPH REGIONAL HEALTH CENTER
Doing business as
St. Joseph Family Medicine Holleman
Practice address
1512 Holleman Dr
College Station, TX 77840-3297
Phone
(979) 764-6885
NPI assigned
May 7, 2013
Last updated
Mar 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Authorized official

Name
Sam Fulton
Title
Director Revenue Cycle
Phone
(979) 774-2079

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1512 Holleman Dr
College Station, TX 77840-3297

Mailing address

2800 S Texas Ave Ste 202
Bryan, TX 77802-5361
Phone (979) 690-4828

Other identifiers 1

IdentifierTypeStateIssuer
081951801MedicaidTX

Other names 1

  • St. Joseph Family Medicine Holleman Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Hospital He9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1487099248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 S TEXAS AVE STE 202",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778025361",
            "telephone_number": "979-690-4828",
            "fax_number": "979-690-4829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 HOLLEMAN DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778403297",
            "telephone_number": "979-764-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH REGIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-07",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "FULTON",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "979-774-2079"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081951801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Joseph Family Medicine Holleman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.