Provider Demographics
NPI:1659849875
Name:EL CENTRO DEL BARRIO, INC
Entity Type:Organization
Organization Name:EL CENTRO DEL BARRIO, INC
Other - Org Name:CENTROMED FAMILY FIRST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-334-3724
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-928-9699
Practice Address - Street 1:9135 SCHAEFER RD STE 4
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1980
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-928-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)