MEDICARE: CC HEALTHCARE SYSTEMS, LLC

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	208D00000X	General Practice Physician	G2964	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1881922102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CC HEALTHCARE SYSTEMS, LLC

Provider Business Mailing Address
First Line	:	705 LANDA STREET
Second Line	:	SUITE C
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-6163
Country	:	US
Telephone Number	:	830-629-3614
Fax Number	:	830-629-2438

Provider Business Practice Location Address
First Line	:	705 LANDA STREET
Second Line	:	SUITE C
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-6163
Country	:	US
Telephone Number	:	830-629-3614
Fax Number	:	830-629-2438

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. SARA ANN CASTANEDA
Credential	:
Telephone Number	:	830-629-3614

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	10/10/2017

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Directions to “CC HEALTHCARE SYSTEMS, LLC ” Practice Location

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