Organization
EL CENTRO DEL BARRIO INC
Active
Other names
CentroMed Southside Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK WALZEL (CFO)
(210) 334-3724
Entity
Organization
Contact information
Practice address
3750 COMMERCIAL AVE, SAN ANTONIO, TX 78221-3117
(210) 334-3700
(210) 922-0162
Mailing address
3750 COMMERCIAL AVE, SAN ANTONIO, TX 78221-3117
(210) 334-3700
(210) 922-0162
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
HBOCS007758-04-00
TX
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
HBOCS00758-04-00
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00MT08
GROUP MEDICARE
TX
05
—
120980101
—
TX
05
—
120980102
—
TX
05
—
120980103
—
TX
05
—
120980106
—
TX
01
—
G60232-01
DELTA DENTAL
TX
Enumeration date
11/15/2006
Last updated
08/18/2011
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