Provider Demographics
NPI:1154495182
Name:EL CENTRO DEL BARRIO, INC.
Entity Type:Organization
Organization Name:EL CENTRO DEL BARRIO, INC.
Other - Org Name:DULLNIG HOUSE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:WALZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-922-0103
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-0103
Mailing Address - Fax:210-271-7208
Practice Address - Street 1:204 NOLAN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2153
Practice Address - Country:US
Practice Address - Phone:210-229-9322
Practice Address - Fax:210-227-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXHBOCS00758-04-00261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MT08OtherGROUP MEDICARE
TX120980101Medicaid
TX120980102Medicaid
TX120980103Medicaid
TX120980105Medicaid
TX120980101Medicaid