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General NPI Number Information
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NPI Number | 1821159518
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Entity Type | Organization
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Legal Business Name | KICKAPOO TRADITIONAL TRIBE OF TEXAS
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 2192 ROSITA VALLEY ROAD
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City | EAGLE PASS
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State | TX
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Zip | 78852-9752
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Country | US
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Telephone | 830-421-5349
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Fax | 830-757-5193
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Provider Business Mailing Address
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Address Line | 2192 ROSITA VALLEY RD
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City | EAGLE PASS
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State | TX
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Zip | 78852-2542
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Country | US
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Telephone | 830-421-5930
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Fax | 830-752-6033
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CYNTHIA RIVERA
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Credential |
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Telephone | 830-421-5926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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