MEDICARE: SOUTH TEXAS PROVIDER AGENCY LLC

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	3747P1801X	Personal Care Attendant
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023966124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS PROVIDER AGENCY LLC

Provider Business Mailing Address
First Line	:	1540 E GARRISON ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4930
Country	:	US
Telephone Number	:	830-335-3445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 E GARRISON ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4930
Country	:	US
Telephone Number	:	830-335-3445
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	GUADALUPE GONZALEZ
Credential	:
Telephone Number	:	830-335-3445

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “SOUTH TEXAS PROVIDER AGENCY LLC ” Practice Location

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