Provider Demographics
NPI:1346567948
Name:VSHSI LPISD COMMUNITY BASED AND SCHOOL BASED CLINIC
Entity Type:Organization
Organization Name:VSHSI LPISD COMMUNITY BASED AND SCHOOL BASED CLINIC
Other - Org Name:VSHSI - LPISDCOMMUNITY BASED & SCHOOL BASED HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-374-2301
Mailing Address - Street 1:308 S. CESAR CHAVEZ AVE.
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839
Mailing Address - Country:US
Mailing Address - Phone:830-374-2301
Mailing Address - Fax:830-374-9368
Practice Address - Street 1:117 E. HWY 57
Practice Address - Street 2:
Practice Address - City:LA PRYOR
Practice Address - State:TX
Practice Address - Zip Code:78872
Practice Address - Country:US
Practice Address - Phone:830-365-4528
Practice Address - Fax:830-365-4023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIDA Y SALUD - HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-23
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)