Provider Demographics
NPI:1356664460
Name:PROJECT VIDA HEALTH CENTER
Entity Type:Organization
Organization Name:PROJECT VIDA HEALTH CENTER
Other - Org Name:PROJECT VIDA HEALTH CENTER - SIERRA BLANCA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLESINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-7057
Mailing Address - Street 1:3607 RIVERA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2415
Mailing Address - Country:US
Mailing Address - Phone:915-533-7057
Mailing Address - Fax:915-533-7158
Practice Address - Street 1:442 RURAL MARKET 1111
Practice Address - Street 2:
Practice Address - City:SIERRA BLANCA
Practice Address - State:TX
Practice Address - Zip Code:79851
Practice Address - Country:US
Practice Address - Phone:915-369-0038
Practice Address - Fax:915-369-0039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT VIDA HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-03
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121004905Medicaid
TX121004906Medicaid
TX121004904Medicaid
TX121004907Medicaid
TX121004906Medicaid
451984Medicare PIN
451985Medicare PIN
671818Medicare PIN