=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164347357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2026
-----------------------------------------------------
Last Update Date | 08/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 CHAMPION AVE
-----------------------------------------------------
City | PORT ISABEL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78578-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-548-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 CHAMPION AVE
-----------------------------------------------------
City | PORT ISABEL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78578-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-548-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | JASON WALLACE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-548-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------