MEDICARE: FORT DUNCAN MEDICAL CENTER, L.P.

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	146D00000X	Personal Emergency Response Attendant	000547	TX
2	133NN1002X	Nutrition Education Nutritionist	722994	TX

General Provider Information

NPI Number	:	1194772186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT DUNCAN MEDICAL CENTER, L.P.

Provider Business Mailing Address
First Line	:	350 S ADAMS ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-5110
Country	:	US
Telephone Number	:	830-773-5321
Fax Number	:	830-758-4872

Provider Business Practice Location Address
First Line	:	350 S ADAMS ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-5110
Country	:	US
Telephone Number	:	830-773-5321
Fax Number	:	830-758-4872

Authorized Official
Title or Position	:	CEO/MANAGING DIRECTOR
Name	:	MR. ALFREDO ONTIVEROS JR.
Credential	:
Telephone Number	:	830-773-5321

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	09/11/2025

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