Organization Name: | ATASCOSA HEALTH CENTER, INC. |
NPI Number: | 1174993745 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MONTY SMALL (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 15033 Main Street Suite Number 104 Lytle |
State: | TX US |
Postal Code: | 78052 |
Phone Number: | 8305698940 |
Fax Number: | 8305698527 |
NPI Enumeration Date: | 09/25/2015 |
NPI Last Update Date: | 10/27/2015 |
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: |