Healthcare Provider Details

I. General information

NPI: 1538351770
Provider Name (Legal Business Name): SOUTH TEXAS RURAL HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S. STEWART
COTULLA TX
78014-0599
US

IV. Provider business mailing address

PO BOX 599
COTULLA TX
78014-0599
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-2676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number13786
License Number StateTX

VIII. Authorized Official

Name: LIDIA RODRIGUEZ
Title or Position: ADMINISTRATOR ASSISTANT/ HR
Credential:
Phone: 830-879-5047