MEDICARE: EL CENTRO DE CORAZON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1013201813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CENTRO DE CORAZON

Provider Business Mailing Address
First Line	:	5001 NAVIGATION BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-1019
Country	:	US
Telephone Number	:	713-926-1849
Fax Number	:	713-926-4244

Provider Business Practice Location Address
First Line	:	4414 NAVIGATION BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-1036
Country	:	US
Telephone Number	:	713-660-1880
Fax Number	:	713-926-9105

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARY JO MAY
Credential	:	DIRECTOR
Telephone Number	:	713-926-1849

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	09/06/2011

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