Provider Demographics
NPI:1821551581
Name:GONZALES HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:GONZALES HEALTHCARE SYSTEMS
Other - Org Name:SIEVERS MEDICAL CLINIC - SHINER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALDUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-672-7581
Mailing Address - Street 1:1110 N SARAH DEWITT DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-3311
Mailing Address - Country:US
Mailing Address - Phone:830-672-7581
Mailing Address - Fax:830-672-8481
Practice Address - Street 1:207 WEST 7TH STREET
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984
Practice Address - Country:US
Practice Address - Phone:361-239-5015
Practice Address - Fax:830-672-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health