MEDICARE: BROWNSVILLE COMMUNITY HEALTH CENTER CORP

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	:	1245421783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWNSVILLE COMMUNITY HEALTH CENTER CORP

Provider Business Mailing Address
First Line	:	2137 E 22ND ST
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2908
Country	:	US
Telephone Number	:	956-548-7400
Fax Number	:	956-546-2056

Provider Business Practice Location Address
First Line	:	142 CHAMPION AVE
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-2908
Country	:	US
Telephone Number	:	956-943-1300
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PAULA S. GOMEZ
Credential	:
Telephone Number	:	956-548-7440

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	10/17/2007

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