Provider Demographics
NPI:1376732099
Name:EDUARDO MORENO, M.D., RURAL HEALTH CLINIC, LLP
Entity Type:Organization
Organization Name:EDUARDO MORENO, M.D., RURAL HEALTH CLINIC, LLP
Other - Org Name:HELEN E MORENO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-497-4272
Mailing Address - Street 1:210 S AVENUE C
Mailing Address - Street 2:P.O. BOX 725
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-3834
Mailing Address - Country:US
Mailing Address - Phone:830-374-2952
Mailing Address - Fax:830-374-3784
Practice Address - Street 1:210 S AVENUE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-3834
Practice Address - Country:US
Practice Address - Phone:830-374-2952
Practice Address - Fax:830-374-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3738207R00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00BT71OtherBLUE CROSS BLUE SHEILD
TX063386901Medicaid
TX063386901Medicaid