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202 James St Brackettville TX 78832-0729 | |
(830) 563-2434 | |
(855) 729-6740 |
Full Name | |
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Speciality | Clinic/Center |
Location | 202 James St, Brackettville, Texas |
Authorized Official Name and Position | Rafael E Olvera (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 8307738917 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1470 Eagle Pass TX 78853-1470 Ph: (830) 773-8917 | 202 James St Brackettville TX 78832-0729 Ph: (830) 563-2434 |
NPI Number | 1336284785 |
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Provider Enumeration Date | 02/21/2007 |
Last Update Date | 11/16/2023 |
Certification Date | 11/16/2023 |
Medicare PECOS PAC ID | 7618957135 |
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Medicare Enrollment ID | O20040723000817 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336284785 | NPI | - | NPPES |
137809306 (FQHC SITE | Medicaid | TX | |
137809302 (GROUPALL) | Medicaid | TX |