Basic Information
| Provider Information | |||||||||
| NPI: | 1356672570 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH TEXAS RURAL HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 599 | ||||||||
| Address2: | |||||||||
| City: | COTULLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780140599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308793047 | ||||||||
| FaxNumber: | 8308792940 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 W HONDO AVE | ||||||||
| Address2: | |||||||||
| City: | DEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780161921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308793047 | ||||||||
| FaxNumber: | 8308792940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZAMORA | ||||||||
| AuthorizedOfficialFirstName: | ALFREDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8308793047 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.