Clinica de la Familia Hispana Ebenezer LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

CLINICA DE LA FAMILIA HISPANA EBENEZER LLC

Practice address

522 Bedford Rd
Bedford, TX 76022-6505

Phone

(682) 738-3358

Fax

(682) 738-3117

NPI assigned

Apr 16, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Addel Castellanos Matos

Title

Owner

Phone

(682) 738-3358

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roselio Perez Garcia, FNP

  • Family Nurse Practitioner
  • Mesquite, TX
  • NPI 1043780513

  Multi-Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1003660895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 BEDFORD RD",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226505",
            "telephone_number": "682-738-3358",
            "fax_number": "682-738-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 BEDFORD RD",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226505",
            "telephone_number": "682-738-3358",
            "fax_number": "682-738-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA DE LA FAMILIA HISPANA EBENEZER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "CASTELLANOS MATOS",
        "authorized_official_first_name": "ADDEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "682-738-3358"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chad Alan Clawson, D.C.
• Jessica Renee Clemons, NP
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• Lora Cobb, NP
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• Cole Associates and Counselors of Texas, PLLC

• Family Nurse Practitioner in Bedford, TX
• Providers in Bedford, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.