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640 E Bravo Blvd Roma TX 78584-5720 | |
(956) 849-2176 | |
(956) 849-4155 |
Full Name | |
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Speciality | Clinic/Center |
Location | 640 E Bravo Blvd, Roma, Texas |
Authorized Official Name and Position | Thalia H Munoz (ADMINISTRATOR) |
Authorized Official Contact | 9564875561 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 78 Rio Grande City TX 78582-0078 Ph: (956) 849-0674 | 640 E Bravo Blvd Roma TX 78584-5720 Ph: (956) 849-2176 |
NPI Number | 1023173507 |
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Provider Enumeration Date | 12/26/2006 |
Last Update Date | 03/09/2020 |
Medicare PECOS PAC ID | 3971567512 |
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Medicare Enrollment ID | O20070118000571 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023173507 | NPI | - | NPPES |
136332708 | Medicaid | TX | |
136332706 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | 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 | |