MEDICARE: PROJECT VIDA HEALTH CENTER

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	:	1700358264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT VIDA HEALTH CENTER

Provider Business Mailing Address
First Line	:	3607 RIVERA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2415
Country	:	US
Telephone Number	:	915-533-7057
Fax Number	:	915-533-7158

Provider Business Practice Location Address
First Line	:	11700 SCHOOL LN
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-4418
Country	:	US
Telephone Number	:	915-533-7057
Fax Number	:	915-533-7158

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM DAVID SCHLESINGER
Credential	:
Telephone Number	:	915-533-7057

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	12/21/2018

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