St Mark'S Medical Center

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ST MARK'S MEDICAL CENTER

Doing business as

St Mark's Medical Clinic

Practice address

2 Saint Marks PL Ste 110
La Grange, TX 78945-1255

Phone

(979) 242-2387

Fax

(979) 242-2206

NPI assigned

Apr 11, 2012

Organization subpart

No

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

Authorized official

Name

Tammy Hartfield

Title

Chief Clinical Officer

Phone

(979) 242-2105

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• St Mark's Medical Clinic Doing business as

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1659638914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT MARKS PL",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789451250",
            "telephone_number": "979-242-2104",
            "fax_number": "979-242-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT MARKS PL STE 110",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789451255",
            "telephone_number": "979-242-2387",
            "fax_number": "979-242-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARK'S MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "HARTFIELD",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "979-242-2105"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0083XM",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176692503",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Mark's Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon M Juno M.D. P.a.
• Amber Simek
• Trina Siptak, PTA
• Alyssa Marie Smidovec, RN
• Southeast Texas Freelance Anesthesia PC
• St Marks Medical Center
• St. Mark'S Medical Center
• Erich Stafford
• Sterling Emergency Services, PA
• Kirby Alana Stolorski, LVN

• General Practice Physician in La Grange, TX
• Providers in La Grange, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.