1124167432 NPI number — BRUSHLAND COMMUNITY HEALTH CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124167432 NPI number — BRUSHLAND COMMUNITY HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUSHLAND COMMUNITY HEALTH CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY ACTION COUNCIL OF SOUTH TEXAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124167432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO GRANDE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78582-0098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-487-2585
Provider Business Mailing Address Fax Number:
956-487-6670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302 SOUTH SAINT MARY'S ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALFURRIAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-325-9404
Provider Business Practice Location Address Fax Number:
361-325-9564
Provider Enumeration Date:
02/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZARATE
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
G
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
956-487-2585

Provider Taxonomy Codes

  • Taxonomy code: 173000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)