Provider Demographics
NPI:1164417085
Name:LOS BARRIOS UNIDOS COMMUNITY CLINIC,INC.
Entity Type:Organization
Organization Name:LOS BARRIOS UNIDOS COMMUNITY CLINIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-651-8732
Mailing Address - Street 1:809 SINGLETON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-4014
Mailing Address - Country:US
Mailing Address - Phone:214-651-8739
Mailing Address - Fax:214-379-2281
Practice Address - Street 1:809 SINGLETON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4014
Practice Address - Country:US
Practice Address - Phone:214-651-8739
Practice Address - Fax:214-379-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60091-01OtherDELTA DENTAL STATE GOV.PR
TX3959OtherPARKLAND COMM.HEALTH PLAN
TX00P022OtherBLUE CROSS & BLUE SHIELD
TX120977702Medicaid
TX120977704Medicaid
TX120977705OtherCSHCN
TX120977701Medicaid
TX120977703Medicaid
TX10003276OtherAMERIGROUP
TX10022414OtherAMERIGROUP