1245002989 NPI number — ZAPATA PRIMARY CARE CLINIC LLC

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 1245002989 NPI number — ZAPATA PRIMARY CARE CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZAPATA PRIMARY CARE CLINIC LLC
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:
Provider Other Organization Name Type Code:
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:
1245002989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7521 COUNTRY CLUB DR APT 506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78041-3398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-774-6020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 S US HIGHWAY 83
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZAPATA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78076-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-750-3429
Provider Business Practice Location Address Fax Number:
956-750-3414
Provider Enumeration Date:
10/26/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SOLIS
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
956-774-6020

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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