Provider Demographics
NPI:1629741558
Name:DR AMERICO M BACA PLLC
Entity Type:Organization
Organization Name:DR AMERICO M BACA PLLC
Other - Org Name:SPENCE LEGACY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVORKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-783-7088
Mailing Address - Street 1:722 S NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2650
Mailing Address - Country:US
Mailing Address - Phone:956-783-7088
Mailing Address - Fax:956-783-5657
Practice Address - Street 1:336 S 8TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-2526
Practice Address - Country:US
Practice Address - Phone:956-689-2456
Practice Address - Fax:956-689-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health