Provider Demographics
NPI:1457513772
Name:GUADALUPE VALLEY MEDICAL CENTER, LP
Entity Type:Organization
Organization Name:GUADALUPE VALLEY MEDICAL CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GAULDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-647-4397
Mailing Address - Street 1:1375 E WALNUT ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5145
Mailing Address - Country:US
Mailing Address - Phone:830-401-4083
Mailing Address - Fax:830-401-4915
Practice Address - Street 1:1375 E WALNUT ST
Practice Address - Street 2:STE 400
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5145
Practice Address - Country:US
Practice Address - Phone:830-401-4083
Practice Address - Fax:830-401-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0339Medicare PIN