Basic Information
| Provider Information | |||||||||
| NPI: | 1144382771 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY ACTION COUNCIL OF SOUTH TEXAS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ZAPATA HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98 | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785820098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564872585 | ||||||||
| FaxNumber: | 9564876670 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 RATHMELL | ||||||||
| Address2: | |||||||||
| City: | ZAPATA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567654367 | ||||||||
| FaxNumber: | 9567654510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ZARATE | ||||||||
| AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9564872585 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Legal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11227506 | 05 | TX | MEDICAID |