MEDICARE: EL CENTRO DEL BARRIO, INC.

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	:	1447805452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CENTRO DEL BARRIO, INC.

Provider Business Mailing Address
First Line	:	3750 COMMERCIAL AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-3117
Country	:	US
Telephone Number	:	210-922-7000
Fax Number	:	210-924-1374

Provider Business Practice Location Address
First Line	:	20627 HUEBNER RD # A101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4765
Country	:	US
Telephone Number	:	210-223-3543
Fax Number	:	210-924-1374

Authorized Official
Title or Position	:	VP/CFO
Name	:	MR. LAWRENCE C WALZEL
Credential	:	CPA, MBA
Telephone Number	:	210-334-3727

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	06/01/2022

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