Amistad Community Health Center Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Robstown, TX
NPI 1114725231 · NPPES record last updated Apr 3, 2025
Key facts
- NPI
- 1114725231
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
- Practice address
- 710 E Main Ave
Robstown, TX 78380-3133 - Phone
- (361) 884-2242
- Fax
- (361) 884-2243
- NPI assigned
- Mar 4, 2025
- Organization subpart
- Yes
- Parent organization (as reported)
- AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Authorized official
- Name
- Clara Talia Peterson
- Title
- Cfo
- Phone
- (361) 886-3066
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 7
Practitioners 27
-
Telisha Bernal, FNP
-
Chelsea Rhiannon Bueno, FNP-C
-
Elizabeth Granados Chavarria, APRN, FNP-C
-
William Mattew Dennis, M.D.
-
Luis Fuentes III, D.O.
-
Nelly Ivonne Garcia Blow, D.O.
-
Lisette Anahi Garcia, LPC
-
David Aaron Guerra, APRN, FNP-BC
-
Riley Diane Huerta, LPC
-
Scott P Krall, MD
-
Elizabeth Ann Loika, ARNP
-
Danea Mickey, LPC
-
Karim N Nooruddin, M.D.
-
Kimberly Renee Price, FNP
-
Leticia M Reyes, LPC
-
Judith E Rubano, MD
-
Jefryn Porter Sellers, FNP-C
-
Lisa Marie Vela, MD
-
Janalee Webb, CNP
-
Molly West, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2327937 | Amistad Community Health Center Inc | Certificate of waiver | Jul 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Federally qualified health center certification: CCN 971064
- Legal name
- AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
- Doing business as
- AMISTAD HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 13, 2025
- Last certification
- May 13, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 710 E Main Ave
Robstown, TX 78380-3133
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Tamiko Richardson |
W-2 Managing Employee |
Mar 6, 2025 | |
| Other | Mar 6, 2025 | ||
| Eric Baggerman |
W-2 Managing Employee | Mar 6, 2025 | |
| Other |
Mar 6, 2025 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Rcm360 LLC |
Federally qualified health center | Operational/Managerial Control | Jan 1, 2020 |
| Amistad Community Health Center Incorporated |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250417002668 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 8527131036 | Practice locations: Robstown, TX |
National Provider Directory
- Tax ID family
- Amistad Comm HLTH Ctr Inc
- Part of
- Amistad Comm HLTH Ctr Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
710 E Main Ave
Robstown, TX 78380-3133
Mailing address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Phone (361) 884-2242
Other names
- Amistad Health
Other providers in Robstown, TX
- Ability Contracting & Consulting
- Academic Based Communication Therapy, PLLC
- Dina W Alnimri
- Amistad Community Health Center Incorporated
- Asher Medical Equipment & Supply Inc
- Lorissa Barrera
- Big Little Words Pediatric Therapy
- Brighter Future Medical, PLLC
All providers in Robstown, TX · Federally Qualified Health Center (FQHC) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.