Provider Demographics
NPI:1285650424
Name:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-672-6511
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:830-672-3024
Practice Address - Street 1:228 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3910
Practice Address - Country:US
Practice Address - Phone:830-672-6511
Practice Address - Fax:830-672-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HE62OtherBLUE CROSS BLUE SHIELD
TX121440502Medicaid
TX083010101Medicaid
TX083010101Medicaid
TX00HE62Medicare PIN