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605 Belknap Pl San Antonio TX 78212-3413 | |
| (210) 737-1212 | |
| (210) 738-8841 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 605 Belknap Pl, San Antonio, Texas |
| Authorized Official Name and Position | Chuck Walzel (CFO) |
| Authorized Official Contact | 2109220103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 922-0103 | 605 Belknap Pl San Antonio TX 78212-3413 Ph: (210) 737-1212 |
| NPI Number | 1013139377 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 03/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013139377 | NPI | - | NPPES |
| 120980102 | Medicaid | TX | |
| 120980103 | Medicaid | TX | |
| 00MT08 | Other | TX | GROUP MEDICARE |
| 120980105 | Medicaid | TX | |
| 102980101 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | HBOCS00758-04-00 (Texas) | Primary |
| 385H00000X | Respite Care | HBOCS007758-04-00 (Texas) | Secondary |
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