Provider Demographics
NPI:1740266444
Name:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Entity type:Organization
Organization Name:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-548-7400
Mailing Address - Street 1:2137 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2908
Mailing Address - Country:US
Mailing Address - Phone:956-548-7400
Mailing Address - Fax:956-546-2056
Practice Address - Street 1:2137 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2908
Practice Address - Country:US
Practice Address - Phone:956-548-7400
Practice Address - Fax:956-546-2056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-15
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092954903OtherCSHCN
TX081775101Medicaid
TX092954901Medicaid
TX091301401Medicaid
TX092954901Medicaid
TX081775101Medicaid