Island Medical College Station, PLLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

ISLAND MEDICAL COLLEGE STATION, PLLC

Practice address

1604 Rock Prairie Rd
College Station, TX 77845-8345

Phone

(979) 764-5101

NPI assigned

Sep 15, 2017

Last updated

Sep 15, 2017By 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

Joan De la Prida

Title

Cfo

Phone

(631) 514-7600

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505433600000",
    "number": "1669991162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92990",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441942990",
            "telephone_number": "330-656-5911",
            "fax_number": "330-656-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 ROCK PRAIRIE RD",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458345",
            "telephone_number": "979-764-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL COLLEGE STATION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2017-09-15",
        "status": "A",
        "authorized_official_last_name": "DE LA PRIDA",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "631-514-7600"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Analisa Jackson
• Holly Jackson, PA-C

• Emergency Medicine Physician in College Station, TX
• Providers in College Station, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; 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.