MEDICARE: DR AMERICO M BACA PLLC

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	261QR1300X	Rural Health Clinic/Center
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	866001	OTHER	TX	MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922564863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR AMERICO M BACA PLLC

Provider Business Mailing Address
First Line	:	417 W FM 495
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-3717
Country	:	US
Telephone Number	:	956-783-7088
Fax Number	:	956-783-5657

Provider Business Practice Location Address
First Line	:	417 W FM 495
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-3717
Country	:	US
Telephone Number	:	956-783-7088
Fax Number	:	956-783-5657

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN W HOVORKA
Credential	:	MD
Telephone Number	:	956-992-9161

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	10/22/2024

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Directions to “DR AMERICO M BACA PLLC ” Practice Location

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