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1505 N Grant St Ste 1 Roma TX 78584-5429 | |
(956) 849-4700 | |
(956) 849-4704 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1505 N Grant St Ste 1, Roma, Texas |
Authorized Official Name and Position | Ana Falcon (ADMINISTRATOR) |
Authorized Official Contact | 9564881200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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201 E 2nd St Rio Grande City TX 78582-3803 Ph: (956) 488-1200 | 1505 N Grant St Ste 1 Roma TX 78584-5429 Ph: (956) 849-4700 |
NPI Number | 1710178181 |
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Provider Enumeration Date | 08/09/2007 |
Last Update Date | 12/06/2023 |
Medicare PECOS PAC ID | 6204880008 |
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Medicare Enrollment ID | O20060620000031 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710178181 | NPI | - | NPPES |
163872804 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | L4155 (Texas) | Primary |
Nuestra Clinica Del Valle Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2891 E Grant St, Roma, TX 78584 Phone: 956-849-2100 Fax: 956-787-8915 | |