Provider Demographics
NPI:1740223379
Name:VALLEY AIDS COUNCIL
Entity Type:Organization
Organization Name:VALLEY AIDS COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ED
Authorized Official - Phone:956-428-2653
Mailing Address - Street 1:418 E. TYLER
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-428-2653
Mailing Address - Fax:956-428-2005
Practice Address - Street 1:418 E TYLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9102
Practice Address - Country:US
Practice Address - Phone:956-428-2653
Practice Address - Fax:956-428-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083627202Medicaid
TX00L08GOtherBCBS OF TEXAS
W29235Medicare UPIN
TX00L08GMedicare ID - Type Unspecified