Provider Demographics
| NPI: | 1336284785 |
|---|---|
| Name: | UNITED MEDICAL CENTERS |
| Entity Type: | Organization |
| Organization Name: | UNITED MEDICAL CENTERS |
| Other - Org Name: | UNITED MEDICAL CENTERS, #2 |
| Other - Org Type: | Other Name |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | RAFAEL |
| Authorized Official - Middle Name: | E |
| Authorized Official - Last Name: | OLVERA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MBA |
| Authorized Official - Phone: | 830-773-8917 |
| Mailing Address - Street 1: | PO BOX 1470 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | EAGLE PASS |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78853-1470 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 830-773-8917 |
| Mailing Address - Fax: | 830-773-1892 |
| Practice Address - Street 1: | 202 JAMES ST |
| Practice Address - Street 2: | |
| Practice Address - City: | BRACKETTVILLE |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78832-0729 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 830-563-2434 |
| Practice Address - Fax: | 855-729-6740 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | UNITED MEDICAL CENTERS |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-02-21 |
| Last Update Date: | 2023-11-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 207Q00000X, 207R00000X, 207RI0011X, 207V00000X, 207Y00000X, 208000000X, 208D00000X, 363A00000X, 363L00000X, 363LP0200X, 363LW0102X | ||
| TX | 213E00000X, 261QF0400X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 137809306 (FQHC SITE | Medicaid | |
| TX | 137809302 (GROUPALL) | Medicaid | |
| TX | 137809306 (FQHC SITE | Medicaid | |
| TX | 137809302 (GROUPALL) | Medicaid | |
| TX | CP7072 (RAILROAD) | Medicare PIN | |
| TX | 00FC58 | Medicare ID - Type Unspecified | MEDICARE TRAILBLAZER |
| TX | 217985501 | Other | LEE T. KEENEN, DPM |
| TX | 138165936 | Other | PALANI S. MANI, MD |
| TX | 1104976539 | Other | JUAN SAUCEDO DO |
| TX | 137809306 | Medicaid | |
| TX | 1740312867 | Other | AURELIO LAING III MD |
| TX | 131765305 | Other | JUAN SAUCEDO,DO OB |
| TX | CP7072 | Medicare ID - Type Unspecified | RAILROAD MEDICARE |
| TX | 1003963984 | Other | AGUSTIN Q LUZ MD |
| TX | 451854 | Medicare ID - Type Unspecified | MEDICARE UGS |
