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	261Q00000X	Clinic/Center	HBOCS00758-04-00	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	:	1427122456
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	:	1514 W DURANGO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3936
Country	:	US
Telephone Number	:	210-224-4991
Fax Number	:	210-224-5023

Authorized Official
Title or Position	:	CFO
Name	:	CHUCK WALZEL
Credential	:
Telephone Number	:	210-334-3700

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/16/2009

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Directions to “EL CENTRO DEL BARRIO, INC. ” Practice Location

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