Organization
EL CENTRO DEL BARRIO, INC
Active
Other names
CentroMed Sarah E. Davidson Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK WALZEL (CFO)
(210) 334-3724
Entity
Organization
Contact information
Practice address
1 HAVEN FOR HOPE WAY BLDG1 #300, SAN ANTONIO, TX 78207-1108
(210) 220-2330
(210) 220-2332
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
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00MT08
GROUP MEDICARE
TX
05
—
120980101
—
TX
05
—
120980102
—
TX
Enumeration date
04/10/2009
Last updated
05/09/2012
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