Provider Demographics
NPI:1841891934
Name:SU CLINICA FAMILIAR
Entity type:Organization
Organization Name:SU CLINICA FAMILIAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUNGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-365-6000
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6000
Mailing Address - Fax:
Practice Address - Street 1:1706 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8911
Practice Address - Country:US
Practice Address - Phone:956-365-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SU CLINICA FAMILIAR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019029001Medicaid