1538264429 NPI number — EL CENTRO DEL BARRIO, INC.

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 1538264429 NPI number — EL CENTRO DEL BARRIO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL CENTRO DEL BARRIO, INC.
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:
CENTROMED SOUTH PARK MEDICAL CLINIC
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:
1538264429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 COMMERCIAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78221-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-334-3700
Provider Business Mailing Address Fax Number:
210-922-0162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6315 S ZARZAMORA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78211-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-977-7910
Provider Business Practice Location Address Fax Number:
210-924-2165
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALZEL
Authorized Official First Name:
CHUCK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
210-334-3724

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  H76HA00124 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00MT08 . This is a "GROUP MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 120980103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120980105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120980101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120980102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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