Healthcare Provider Details

I. General information

NPI: 1346567948
Provider Name (Legal Business Name): VSHSI LPISD COMMUNITY BASED AND SCHOOL BASED CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E. HWY 57
LA PRYOR TX
78872
US

IV. Provider business mailing address

308 S. CESAR CHAVEZ AVE.
CRYSTAL CITY TX
78839
US

V. Phone/Fax

Practice location:
  • Phone: 830-365-4528
  • Fax: 830-365-4023
Mailing address:
  • Phone: 830-374-2301
  • Fax: 830-374-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. NORA TELLEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 830-374-2301