Provider Demographics
NPI:1013196625
Name:PREVENTATIVE CARE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PREVENTATIVE CARE HEALTH SERVICES, INC.
Other - Org Name:PRESIDIO COUNTY HEALTH SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-837-4812
Mailing Address - Street 1:1605 N FT DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830
Mailing Address - Country:US
Mailing Address - Phone:432-837-4812
Mailing Address - Fax:432-837-4823
Practice Address - Street 1:406 S SUMMER ST
Practice Address - Street 2:
Practice Address - City:MARFA
Practice Address - State:TX
Practice Address - Zip Code:79843
Practice Address - Country:US
Practice Address - Phone:432-729-1800
Practice Address - Fax:432-729-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189915501Medicaid
TX67-1881OtherMEDICARE CCN OR PTAN
TX67-1881Medicare PIN