Organization
EL CENTRO DEL BARRIO, INC.
Active
Other names
CentroMed Pharmacy- Walzem
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK WALZEL (CFO)
(210) 334-3724
Entity
Organization
Contact information
Practice address
5542 WALZEM RD., SAN ANTONIO, TX 78221-3117
(210) 637-2420
(210) 637-2424
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
H80CS007581002
TX
3336C0002X
Clinic Pharmacy
H80CS007581002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00MT08
GROUP MEDICARE
TX
05
—
120980101
—
TX
05
—
120980102
—
TX
05
—
120980103
—
TX
05
—
192233801
—
TX
Enumeration date
12/14/2011
Last updated
12/14/2011
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