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General NPI Number Information
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NPI Number | 1386770147
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Entity Type | Organization
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Legal Business Name | AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 1533 S. BROWNLEE BLVD. STE. 100
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-3131
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Country | US
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Telephone | 361-884-2242
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Fax | 361-884-2243
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Provider Business Mailing Address
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Address Line | 1533 S BROWNLEE BLVD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-3131
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Country | US
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Telephone | 361-844-2242
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Fax | 361-844-2243
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Authorized Official
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Title or Position | CFO
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Name | CLARA TALIA PETERSON
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Credential |
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Telephone | 361-886-3066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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