St. Monica'S Outreach Center for Addictive Disorders

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

3474-3475 Issued in TX

Legal business name

ST. MONICA'S OUTREACH CENTER FOR ADDICTIVE DISORDERS

Practice address

1703 E 29TH St
Bryan, TX 77802-1406

Phone

(979) 779-4756

Fax

(979) 823-3018

NPI assigned

Nov 15, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Rany A Cherian, M.D.

Title

President

Phone

(979) 779-4756

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1780961920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 E 29TH ST",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778021406",
            "telephone_number": "979-779-4756",
            "fax_number": "979-823-3018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 E 29TH ST",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778021406",
            "telephone_number": "979-779-4756",
            "fax_number": "979-823-3018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MONICA'S OUTREACH CENTER FOR ADDICTIVE DISORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-15",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "CHERIAN",
        "authorized_official_first_name": "RANY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-779-4756",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "TX",
            "license": "3474-3475",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TX",
            "license": "3474-3475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DEPARTMENT OF STATE HEALTH SERVICES",
            "identifier": "3474-3475",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ryan Michael Stadig, DPT
• Celeste Stagg, LPC ASSOCIATE
• Page Staley

• All providers in Bryan, TX
• Substance Use Disorder Rehabilitation Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; 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.