Organization Name: | LA ESPERANZA CLINIC, INC. |
NPI Number: | 1043489347 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MIKE CAMPBELL (CEO) |
Mailing Address: | 35 E 31st St San Angelo |
State: | TX US |
Postal Code: | 769032207 |
Phone Number: | 3259448900 |
Fax Number: | |
NPI Enumeration Date: | 02/21/2008 |
NPI Last Update Date: | 12/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |