Provider Demographics
NPI:1811999337
Name:GONZALES HEALTHCARE SYSTEMS
Entity type:Organization
Organization Name:GONZALES HEALTHCARE SYSTEMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
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:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0587
Mailing Address - Country:US
Mailing Address - Phone:830-672-7581
Mailing Address - Fax:830-672-2401
Practice Address - Street 1:1818 E US HWY 90
Practice Address - Street 2:
Practice Address - City:WAELDER
Practice Address - State:TX
Practice Address - Zip Code:78959
Practice Address - Country:US
Practice Address - Phone:830-672-7581
Practice Address - Fax:830-672-2401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GONZALES HEALTHCARE SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-15
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000103207Q00000X, 208000000X
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091887201Medicaid
TX091887202Medicaid
TX091887202Medicaid