Centromed South Park Dental
LBN: El Centro Del Barrio Inc
Centromed South Park Dental is an health care organization with primary practice located at 910 Wagner Ave , San Antonio TX 78211-3213. The organization recently has 3 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Oral and Maxillofacial Surgery, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty.
El Centro Del Barrio Inc can be contacted via phone (210) 924-7344, or through Walzel, Chuck via phone (210) 334-3724.
Contact Information
Primary practice address
910 Wagner Ave
San Antonio TX 78211-3213
Phone: (210) 924-7344
Fax: (210) 923-7929
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | HBOCS00758-04-00 | Texas |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | HBOCS00758-04-00 | Texas |
| Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) | 261QF0400X | HBOCS007758-04-00 | Texas |
Profile Details
| NPI number | 1497935233 |
|---|---|
| LBN Legal business name | El Centro Del Barrio Inc |
| DBA Doing business as | Centromed South Park Dental |
| Authorized official | Walzel, Chuck |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 9th, 2007 |
| Last updated | Jun 1st, 2012 - about 12 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497935233 | NPPES |
| Texas | MEDICAID | 120980103 | |
| Texas | Other | 00MT08 | |
| Texas | MEDICAID | 120980102 | |
| Texas | MEDICAID | 102980101 | |
| Texas | Other | G60232-02 | |
| Texas | MEDICAID | 120980105 |
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