Organization
PEDIATRIC SPECIALTY RURAL HEALTH CLINIC,LTD
Active
Other names
d/b/a Eagle Pass Pediatric Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA W DE LOS SANTOS (CEO)
(830) 773-1103
Entity
Organization
Contact information
Practice address
710 WILLIAMS ST, EAGLE PASS, TX 78852-5126
(830) 773-1103
(830) 757-8366
Mailing address
PO BOX 2368, EAGLE PASS, TX 78853-2368
(830) 773-1103
(830) 757-8366
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
F3442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130941102
DR.RICARDO DE LOS SANTOS
TX
01
—
742708192
TAX ID
TX
01
—
8127J1
BLUECROSSBLUESHIELD
TX
Enumeration date
10/04/2006
Last updated
11/03/2010
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