Healthcare Provider Details

I. General information

NPI: 1285066779
Provider Name (Legal Business Name): CHAMPION PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W MAIN ST STE C
PFLUGERVILLE TX
78660-2775
US

IV. Provider business mailing address

104 W MAIN ST STE C
PFLUGERVILLE TX
78660-2775
US

V. Phone/Fax

Practice location:
  • Phone: 956-857-7086
  • Fax: 210-455-2027
Mailing address:
  • Phone: 956-857-7086
  • Fax: 210-455-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: EFRAIN EDUARDO GUTIERREZ
Title or Position: SUPERVISOR
Credential:
Phone: 956-400-8810