Provider Demographics
NPI:1679683890
Name:SOUTH TEXAS PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:SOUTH TEXAS PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-725-3804
Mailing Address - Street 1:200 W LYON ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-2510
Mailing Address - Country:US
Mailing Address - Phone:956-725-3804
Mailing Address - Fax:956-725-0182
Practice Address - Street 1:200 W LYON ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-2510
Practice Address - Country:US
Practice Address - Phone:956-725-3804
Practice Address - Fax:956-725-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006398251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health