| |
779 N Texas Blvd Alice TX 78332-3883 | |
(361) 668-0919 | |
(361) 668-0816 |
Full Name | |
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Speciality | Family Medicine |
Location | 779 N Texas Blvd, Alice, Texas |
Authorized Official Name and Position | Sergio Saul Cantu (PRESIDENT) |
Authorized Official Contact | 2103797480 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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779 N Texas Blvd Alice TX 78332-3883 Ph: (361) 668-0919 | 779 N Texas Blvd Alice TX 78332-3883 Ph: (361) 668-0919 |
NPI Number | 1972874287 |
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Provider Enumeration Date | 01/18/2012 |
Last Update Date | 12/12/2023 |
Medicare PECOS PAC ID | 8426211095 |
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Medicare Enrollment ID | O20120517000347 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972874287 | NPI | - | NPPES |
300671001 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | P0707 (Texas) | Primary |
Provider Name | Sergio S Cantu |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1770862047 PECOS PAC ID: 3375710387 Enrollment ID: I20120228000764 |
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