Provider Demographics
NPI:1164868998
Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Entity Type:Organization
Organization Name:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Other - Org Name:COMMUNITY ACTION HEALTH CENTER KLEBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IEXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-0145
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:SUITES 303 AND C
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7150
Practice Address - Country:US
Practice Address - Phone:361-592-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-20
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171353904Medicaid
671846Medicare PIN