Healthcare Provider Details

I. General information

NPI: 1194772186
Provider Name (Legal Business Name): FORT DUNCAN MEDICAL CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S ADAMS ST
EAGLE PASS TX
78852-5110
US

IV. Provider business mailing address

350 S ADAMS ST
EAGLE PASS TX
78852-5110
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-5321
  • Fax: 830-758-4872
Mailing address:
  • Phone: 830-773-5321
  • Fax: 830-758-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number722994
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number000547
License Number StateTX

VIII. Authorized Official

Name: MR. ALFREDO ONTIVEROS JR.
Title or Position: CEO/MANAGING DIRECTOR
Credential:
Phone: 830-773-5321