MEDICARE: KICKAPOO TRADITIONAL TRIBE OF TEXAS

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	261QH0100X	Health Service Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HSZ222	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821159518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KICKAPOO TRADITIONAL TRIBE OF TEXAS

Provider Business Mailing Address
First Line	:	2192 ROSITA VALLEY RD
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-2542
Country	:	US
Telephone Number	:	830-421-5930
Fax Number	:	830-752-6033

Provider Business Practice Location Address
First Line	:	2192 ROSITA VALLEY ROAD
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-9752
Country	:	US
Telephone Number	:	830-421-5349
Fax Number	:	830-757-5193

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CYNTHIA RIVERA
Credential	:
Telephone Number	:	830-421-5926

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/18/2026

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Directions to “KICKAPOO TRADITIONAL TRIBE OF TEXAS ” Practice Location

Language	Start Address	Practice Location

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