Healthcare Provider Details

I. General information

NPI: 1396904686
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S. LAUREL AVENUE
LULING TX
78648-2624
US

IV. Provider business mailing address

PO BOX 1890
GONZALES TX
78629-1390
US

V. Phone/Fax

Practice location:
  • Phone: 830-875-6399
  • Fax: 830-875-6398
Mailing address:
  • Phone: 830-672-6511
  • Fax: 830-672-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL DE LA PAZ
Title or Position: CEO
Credential:
Phone: 830-672-6511