Healthcare Provider Details

I. General information

NPI: 1063267037
Provider Name (Legal Business Name): MAVERICK COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 N VETERANS BLVD STE A
EAGLE PASS TX
78852-6695
US

IV. Provider business mailing address

3406 BOB ROGERS DR STE 120
EAGLE PASS TX
78852-5942
US

V. Phone/Fax

Practice location:
  • Phone: 830-213-8815
  • Fax: 830-757-8708
Mailing address:
  • Phone: 830-213-8815
  • Fax: 830-757-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NESTOR DANIEL BONILLA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 830-757-4990