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General NPI Number Information
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NPI Number | 1558611475
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS INC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 4206 RETAMA CIR
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City | VICTORIA
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State | TX
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Zip | 77901-2765
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Country | US
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Telephone | 361-576-2110
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Fax | 361-576-7460
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Provider Business Mailing Address
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Address Line | PO BOX 1890
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City | GONZALES
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State | TX
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Zip | 78629-1390
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Country | US
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Telephone | 830-672-6511
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAFAEL DE LA PAZ
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Credential |
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Telephone | 830-672-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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