MEDICARE: EL CENTRO DEL BARRIO, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	HBOCS00-04-00	TX
2	261QF0400X	Federally Qualified Health Center (FQHC)	HBOCS00758-04-00	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00MT08	OTHER	TX	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356562680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CENTRO DEL BARRIO, INC.

Provider Business Mailing Address
First Line	:	3750 COMMERCIAL AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-3117
Country	:	US
Telephone Number	:	210-334-3700
Fax Number	:	210-922-0162

Provider Business Practice Location Address
First Line	:	4040 HIGH RIDGE CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4143
Country	:	US
Telephone Number	:	210-212-2525
Fax Number	:	210-340-5022

Authorized Official
Title or Position	:	CFO
Name	:	CHUCK WALZEL
Credential	:
Telephone Number	:	210-334-3724

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	01/26/2010

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