Provider Demographics
NPI:1467001388
Name:EMMANUEL PRIMARY CARE SERVICES LLC
Entity type:Organization
Organization Name:EMMANUEL PRIMARY CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-271-8588
Mailing Address - Street 1:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0050
Mailing Address - Country:US
Mailing Address - Phone:956-271-8588
Mailing Address - Fax:
Practice Address - Street 1:713 N BENTSEN PALM DR STE D
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78574-3797
Practice Address - Country:US
Practice Address - Phone:956-271-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty