Provider Demographics
NPI:1033440243
Name:SOUTH TEXAS RURAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTH TEXAS RURAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-879-3047
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-0599
Mailing Address - Country:US
Mailing Address - Phone:830-879-3047
Mailing Address - Fax:830-879-2940
Practice Address - Street 1:150 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6624
Practice Address - Country:US
Practice Address - Phone:830-879-3047
Practice Address - Fax:830-879-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0190506-01Medicaid