Provider Demographics
NPI:1275066912
Name:TEXAS FEDERAL WELLNESS CENTER OF BROWNSVILLE
Entity Type:Organization
Organization Name:TEXAS FEDERAL WELLNESS CENTER OF BROWNSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-561-4894
Mailing Address - Street 1:1000 CALLE MILAGROS
Mailing Address - Street 2:A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-0022
Mailing Address - Country:US
Mailing Address - Phone:956-561-4894
Mailing Address - Fax:956-561-4893
Practice Address - Street 1:1000 CALLE MILAGROS
Practice Address - Street 2:A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-0022
Practice Address - Country:US
Practice Address - Phone:956-561-4894
Practice Address - Fax:956-561-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty