El Centro Del Barrio INC
Clinic/Center, Federally Qualified Health Center (FQHC) in San Antonio, TX. Organization (NPI-2).
NPI number1497935233
StatusActive
Last updated in NPPESJun 1, 2012
Details
- NPI
- 1497935233
- Entity type
- Organization (NPI-2)
- Legal business name
- El Centro Del Barrio INC
- Organization subpart
- No
- Enumeration date
- Nov 9, 2007
- Last updated
- Jun 1, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | HBOCS007758-04-00 | TX | Yes |
| 1223G0001X | Dentist, General Practice | HBOCS00758-04-00 | TX | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | HBOCS00758-04-00 | TX |
Other names
- Centromed South Park Dental (Doing Business As)
Practice location
910 Wagner AveSan Antonio, TX 78211-3213
Phone 210-924-7344 · Fax 210-923-7929
Mailing address
3750 Commercial AveSan Antonio, TX 78221-3117
Phone 210-334-3700 · Fax 210-922-0162
Authorized official
Chuck Walzel
Cfo
2103343724
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