Organization
AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Active
Other names
Amistad Health
Organization subpart
No
Provider details
NPI number
Authorized official
CLARA TALIA PETERSON (CFO)
(361) 886-3066
Entity
Organization
Contact information
Practice address
1533 S. BROWNLEE BLVD., STE. 100, CORPUS CHRISTI, TX 78404-3131
(361) 884-2242
(361) 884-2243
Mailing address
1533 S BROWNLEE BLVD, CORPUS CHRISTI, TX 78404-3131
(361) 844-2242
(361) 844-2243
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191099401
—
TX
01
—
215071601
MEDICAID TPI MULTISPECIALTY - GROUP
TX
Enumeration date
02/26/2007
Last updated
04/03/2025
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