Provider Demographics
NPI:1609848332
Name:EL CENTRO DE CORAZON
Entity Type:Organization
Organization Name:EL CENTRO DE CORAZON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-926-1849
Mailing Address - Street 1:5001 NAVIGATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-1019
Mailing Address - Country:US
Mailing Address - Phone:713-926-1849
Mailing Address - Fax:713-926-4244
Practice Address - Street 1:5001 NAVIGATION BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-1019
Practice Address - Country:US
Practice Address - Phone:713-926-1849
Practice Address - Fax:713-926-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2015-07-08
Deactivation Date:2015-06-08
Deactivation Code:
Reactivation Date:2015-07-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1696395-02Medicaid
TX451983Medicare ID - Type UnspecifiedNAVIGATION SITE