Provider Demographics
NPI:1407406333
Name:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Other - Org Name:BASTROP ISD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-672-6511
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:830-672-6430
Practice Address - Street 1:1602 HILL ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-2525
Practice Address - Country:US
Practice Address - Phone:830-672-6511
Practice Address - Fax:830-672-6430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-12
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)