Basic Information
| Provider Information | |||||||||
| NPI: | 1821096140 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UVALDE COUNTY HOSPITAL AUTHORITY | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HEALTHCARE CLINIC OF SABINAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 GARNER FLD RD | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302786251 | ||||||||
| FaxNumber: | 8302783756 | ||||||||
| Practice Location | |||||||||
| Address1: | 517 N. CENTER ST | ||||||||
| Address2: | |||||||||
| City: | SABINAL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788810509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309882985 | ||||||||
| FaxNumber: | 8309882410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUCKNER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8302786251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 88230G | 01 | TX | BCBS | OTHER |