Provider Demographics
NPI:1093890634
Name:PREVENTATIVE CARE HEALTH SERVICE, INC.
Entity Type:Organization
Organization Name:PREVENTATIVE CARE HEALTH SERVICE, 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 DAVID 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 1:1501 N ERMA AVE
Practice Address - Street 2:
Practice Address - City:PRESIDIO
Practice Address - State:TX
Practice Address - Zip Code:79845
Practice Address - Country:US
Practice Address - Phone:432-229-3030
Practice Address - Fax:432-229-2500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVENTATIVE CARE HEALTH SERVICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
261QD0000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189714201Medicaid
TX189714201Medicaid
TX67-1882Medicare PIN