Provider Demographics
NPI:1386635951
Name:FORT DUNCAN MEDICAL CENTER LP
Entity Type:Organization
Organization Name:FORT DUNCAN MEDICAL CENTER LP
Other - Org Name:FORT DUNCAN REGIONAL MEDICAL CENTER CRNA GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:3333 N FOSTER MALDONADO BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852
Mailing Address - Country:US
Mailing Address - Phone:830-773-5321
Mailing Address - Fax:
Practice Address - Street 1:3333 N FOSTER MALDONADO BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852
Practice Address - Country:US
Practice Address - Phone:830-773-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C71POtherBCBS OF TX
TX1108037-01Medicaid
TX00C71POtherBCBS OF TX