| D/b/a Eagle Pass Pediatric Health Clinic | |
|
710 Williams St Eagle Pass TX 78852-5126 | |
| (830) 773-1103 | |
| (830) 757-8366 |
| Full Name | D/b/a Eagle Pass Pediatric Health Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 710 Williams St, Eagle Pass, Texas |
| Authorized Official Name and Position | Debra W De Los Santos (CEO) |
| Authorized Official Contact | 8307731103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D/b/a Eagle Pass Pediatric Health Clinic Po Box 2368 Eagle Pass TX 78853-2368 Ph: (830) 773-1103 | D/b/a Eagle Pass Pediatric Health Clinic 710 Williams St Eagle Pass TX 78852-5126 Ph: (830) 773-1103 |
| NPI Number | 1851486500 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 11/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851486500 | NPI | - | NPPES |
| 130941102 | Other | TX | DR.RICARDO DE LOS SANTOS |
| 742708192 | Other | TX | TAX ID |
| 8127J1 | Other | TX | BLUECROSSBLUESHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | F3442 (Texas) | Primary |
Eagle Pass Pediatric Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 710 Williams St, Eagle Pass, TX 78852 Phone: 830-773-1103 Fax: 830-757-8366 | |
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