Organization
EL CENTRO DEL BARRIO, INC.
Active
Other names
CentroMed South Park Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHUCK WALZEL MBA, CPA (CHIEF FINANCIAL OFFICER)
(210) 334-3724
Entity
Organization
Contact information
Practice address
6315 S ZARZAMORA ST, SAN ANTONIO, TX 78211-3218
(210) 977-7910
(210) 924-2165
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
H76HA00124
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00MT08
GROUP MEDICARE
TX
05
—
120980101
—
TX
05
—
120980102
—
TX
05
—
120980103
—
TX
05
—
120980105
—
TX
Enumeration date
09/14/2006
Last updated
10/11/2019
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