1760556773 NPI number — EL CENTRO DEL BARRIO, INC.

Table of content: (NPI 1760556773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760556773 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:
Provider Other Organization Name Type Code:
6
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:
1760556773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2011
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:
5542 WALZEM RD
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:
78239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-637-2450
Provider Business Practice Location Address Fax Number:
210-590-8970
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  HBOCS00758-04-00 , 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: 120980101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120980103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00MT08 . This is a "GROUP MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 192233801 , 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: 120980102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G60232-04 . This is a "DELTA DENTAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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