MEDICARE: BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION

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	:	1538218458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION

Provider Business Mailing Address
First Line	:	95 E PRICE RD
Second Line	:	BLDG D
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-3578
Country	:	US
Telephone Number	:	956-546-3209
Fax Number	:	956-544-8120

Provider Business Practice Location Address
First Line	:	95 E PRICE RD
Second Line	:	BLDG D
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-3578
Country	:	US
Telephone Number	:	956-546-3209
Fax Number	:	956-544-8120

Authorized Official
Title or Position	:	CEO
Name	:	JASON K WALLACE
Credential	:
Telephone Number	:	956-548-7400

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	06/03/2025

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