Organization
EL CENTRO DEL BARRIO, INC.
Active
Other names
CentroMed Santa RosaClinic/Ryran White Clinic, CentroMed Santa Rosa Clinic/Ryan White Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK WALZEL (VP/CFO)
(210) 334-3724
Entity
Organization
Contact information
Practice address
315 N SAN SABA, SUITE # 103, SAN ANTONIO, TX 78207-3154
(210) 922-7000
(210) 924-1374
Mailing address
3750 COMMERCIAL AVE, SAN ANTONIO, TX 78221-3117
(210) 334-3700
(210) 922-0162
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
HBOCS00758-04-00
TX
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
HBOCS00758-04-00
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
11/24/2006
Last updated
10/25/2019
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