Organization
KICKAPOO TRADITIONAL TRIBE OF TEXAS
Active
Other names
Texas Band of Kickapoo
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA RIVERA (OFFICE MANAGER)
(830) 421-5926
Entity
Organization
Contact information
Practice address
2192 ROSITA VALLEY ROAD, EAGLE PASS, TX 78852-9752
(830) 421-5349
(830) 757-5193
Mailing address
2192 ROSITA VALLEY RD, EAGLE PASS, TX 78852-2542
(830) 421-5930
(830) 752-6033
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200158801
—
TX
01
—
HSZ222
MEDICARE
TX
Enumeration date
12/13/2006
Last updated
03/18/2026
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