Organization
MAVERICK COUNTY MEDICAL FAMILY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SOSA (CREDENTIALING AND ENROLLMENT MANAGE)
(508) 213-1947
Entity
Organization
Contact information
Practice address
590 E MAIN ST STE A, EAGLE PASS, TX 78852-4773
(830) 773-3331
(830) 773-2981
Mailing address
2239 ACAPULCO DR, EAGLE PASS, TX 78852-4101
(210) 394-9171
(830) 773-2981
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12848606
—
TX
Enumeration date
03/07/2007
Last updated
11/10/2021
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