Organization
EL CENTRO DEL BARRIO INC
Active
Other names
CentroMed Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK WALZEL (CFO)
(210) 334-3724
Entity
Organization
Contact information
Practice address
918 WAGNER, SAN ANTONIO, TX 78211-3218
(210) 932-3500
(210) 924-6778
Mailing address
3750 COMMERCIAL AVE, SAN ANTONIO, TX 78221-3117
(210) 334-3700
(210) 922-0162
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
HBOCS007580400
TX
3336C0002X
Clinic Pharmacy
HBOCS007580400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00MT08
GROUP MEDICARE
TX
05
—
120980101
—
TX
05
—
120980102
—
TX
05
—
120980103
—
TX
01
—
4587537
NABP
TX
Enumeration date
02/07/2007
Last updated
11/03/2011
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