Provider Demographics
NPI:1467583286
Name:MAVERICK COUNTY MEDICAL FAMILY CENTER
Entity Type:Organization
Organization Name:MAVERICK COUNTY MEDICAL FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND ENROLLMENT MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-213-1947
Mailing Address - Street 1:2239 ACAPULCO DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4101
Mailing Address - Country:US
Mailing Address - Phone:210-394-9171
Mailing Address - Fax:830-773-2981
Practice Address - Street 1:590 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4773
Practice Address - Country:US
Practice Address - Phone:830-773-3331
Practice Address - Fax:830-773-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12848606Medicaid
TXG008273137Medicare ID - Type Unspecified
TX12848606Medicaid