MEDICARE: BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1740266444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION

Provider Business Mailing Address
First Line	:	2137 E 22ND ST
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2908
Country	:	US
Telephone Number	:	956-548-7400
Fax Number	:	956-546-2056

Provider Business Practice Location Address
First Line	:	2137 E 22ND ST
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2908
Country	:	US
Telephone Number	:	956-548-7400
Fax Number	:	956-546-2056

Authorized Official
Title or Position	:	CEO
Name	:	JASON K WALLACE
Credential	:
Telephone Number	:	956-548-7400

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/13/2025

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