NPIMap

Organization Active NPI

Stephen F Austin Community Health Center, Inc

Doing business as Mychn Technology Drive

  • Federally Qualified Health Center (FQHC)
  • Angleton, TX
National Provider Identifier
1679258941
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Doing business as
Mychn Technology Drive
Practice address
4005 Technology Drive, Suite 1190
Angleton, TX 77515-2557
Phone
(281) 824-1480
Fax
(281) 220-6407
NPI assigned
Jun 15, 2023
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Courtney Gaines
Title
Credentialing Coordinator II
Phone
(281) 824-1480

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

4005 Technology Drive, Suite 1190
Angleton, TX 77515-2557

Mailing address

1612 Callaway Dr
Alvin, TX 77511-3743
Phone (281) 824-1480

Other names 1

  • MYCHN TECHNOLOGY DRIVE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240401001810 TX Part A Provider - Federally Qualified Health Center (FQHC) 6204977127 Practice locations: Angleton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679258941. Details of each certification follow.

Federally qualified health center certification: CCN 741137

Legal name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC.
Doing business as
MYCHN TECHNOLOGY DRIVE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 18, 2024
Last certification
Mar 18, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 2023 in TX
Enrollment address
4005 Technology Rd
Ste 1190
Angleton, TX 77515-2562

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2280602Mychn Technology Drive4005 Technology Dr Ste 1190, Angleton, TX 77515Certificate of waiverApr 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
CHN Pharmacy28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

1111 W Adoue St
Alvin, TX 77511
Phone 2818241480 ext. 1594

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marbella Hooper Individual 5% Or Greater Indirect Ownership InterestSecretary of the Board Aug 1, 2017
Corporate DirectorSecretary of the Board Aug 1, 2017
Brandy Smith Individual W-2 Managing EmployeeCredentialing Specialist Apr 7, 2016
Mark Young Individual 5% Or Greater Direct Ownership InterestCeo Apr 1, 2010
5% Or Greater Indirect Ownership InterestCeo Apr 1, 2010
Corporate OfficerCheif Executive Officer Apr 1, 2010
Corporate DirectorCeo Apr 1, 2010
Operational/Managerial ControlCeo Apr 1, 2010
Gilberto Romero Individual 5% Or Greater Indirect Ownership InterestMember of the Board Dec 16, 2019
Corporate DirectorMember of the Board Dec 16, 2019
Cheryl Sellers Individual 5% Or Greater Indirect Ownership InterestMember of the Board Oct 21, 2020
Corporate DirectorMember of the Board Oct 21, 2020
Debra Fontenot Individual 5% Or Greater Indirect Ownership InterestMember of the Board Aug 21, 2018
Corporate DirectorMember of the Board Aug 21, 2018
Adam Martinez Individual 5% Or Greater Indirect Ownership InterestMember of the Board Nov 15, 2023
Corporate DirectorMember of the Board Nov 15, 2023
Andrea Nguyen Individual 5% Or Greater Indirect Ownership InterestMember of the Board Oct 18, 2023
Corporate DirectorMember of the Board Oct 18, 2023
Bonnie Horton Individual 5% Or Greater Indirect Ownership InterestMember of the Board Apr 8, 2008
Corporate DirectorMember of the Board Apr 8, 2008
Cornelia Jammer Individual 5% Or Greater Indirect Ownership InterestTreasurer of the Board Feb 19, 2019
Corporate DirectorTreasurer of the Board Feb 19, 2019
Gerald Roznovsky Individual 5% Or Greater Indirect Ownership InterestChairman of the Board Apr 8, 2008
Corporate DirectorChairman of the Board Apr 8, 2008
Gina Adams Individual 5% Or Greater Indirect Ownership InterestVice Chairman of the Board Jan 1, 2015
Corporate DirectorVice Chairman of the Board Jan 1, 2015
Isabel Sanchez Individual 5% Or Greater Indirect Ownership InterestMember of the Board Dec 16, 2019
Corporate DirectorMember of the Board Dec 16, 2019

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stephen F Austin Community Health Center, Inc.Alvin, TX, CCN 671934 Federally qualified health center Operational/Managerial Control Nov 24, 2009
Mychn CallawayAlvin, TX, CCN 741976 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2017
Women and Children's Health CenterAlvin, TX, CCN 451000 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 3, 2016
Pearland Family Health CenterPearland, TX, CCN 451039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 9, 2018
Mychn WebsterWebster, TX, CCN 971091 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 16, 2017

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1679258941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 CALLAWAY DR",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775113743",
            "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": "4005 TECHNOLOGY DRIVE, SUITE 1190",
            "city": "ANGLETON",
            "state": "TX",
            "postal_code": "775152557",
            "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": "2023-06-15",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR II",
        "authorized_official_telephone_number": "281-824-1480"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MYCHN TECHNOLOGY DRIVE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MYCHN TECHNOLOGY DRIVE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Angleton, TX

Sources for this page

Verify at the official NPI Registry.