| Centro San Vicente | |
|
1208 Myrtle Ave El Paso TX 79901-1602 | |
| (915) 351-8972 | |
| Not Available |
| Full Name | Centro San Vicente |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1208 Myrtle Ave, El Paso, Texas |
| Authorized Official Name and Position | Jose Luna (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9152250670 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centro San Vicente 1208 Myrtle Ave El Paso TX 79901-1602 Ph: (915) 351-8972 | Centro San Vicente 1208 Myrtle Ave El Paso TX 79901-1602 Ph: (915) 351-8972 |
| NPI Number | 1841480902 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 04/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841480902 | NPI | - | NPPES |
| 130880107 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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