MEDICARE: PREVENTATIVE CARE HEALTH SERVICE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207Q00000X	Family Medicine Physician	TX
2	261QF0400X	Federally Qualified Health Center (FQHC)
3	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093890634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTATIVE CARE HEALTH SERVICE, INC.

Provider Business Mailing Address
First Line	:	1605 N FT DAVID HWY
Second Line	:	SUITE B
City	:	ALPINE
State	:	TX
Zip	:	79830
Country	:	US
Telephone Number	:	432-837-4812
Fax Number	:	432-837-4823

Provider Business Practice Location Address
First Line	:	1501 N ERMA AVE
Second Line	:
City	:	PRESIDIO
State	:	TX
Zip	:	79845
Country	:	US
Telephone Number	:	432-229-3030
Fax Number	:	432-229-2500

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LINDA MOLINAR
Credential	:
Telephone Number	:	432-837-4812

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	11/04/2022

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