Provider Demographics
NPI:1598980526
Name:SOUTH TEXAS WOMEN'S & CHILDREN'S HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH TEXAS WOMEN'S & CHILDREN'S HEALTH CENTER
Other - Org Name:STWCHC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:956-668-1200
Mailing Address - Street 1:1200 E SAVANNAH AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1728
Mailing Address - Country:US
Mailing Address - Phone:956-668-1200
Mailing Address - Fax:956-668-1212
Practice Address - Street 1:1200 E SAVANNAH AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1727
Practice Address - Country:US
Practice Address - Phone:956-668-1200
Practice Address - Fax:956-668-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151311101Medicaid
TX151311102Medicaid
TX151311101Medicaid