Atascosa Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Three Rivers, TX
NPI 1336491083 · NPPES record last updated Apr 11, 2022
Key facts
- NPI
- 1336491083
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ATASCOSA HEALTH CENTER, INC.
- Practice address
- 105 E. Thornton
Three Rivers, TX 78071 - Phone
- (361) 786-3618
- Fax
- (361) 786-3649
- NPI assigned
- Oct 4, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- ATASCOSA HEALTH CENTER, INC.
Authorized official
- Name
- Monty Small, CMPE
- Title
- Ceo
- Phone
- (830) 569-8940
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 7
Practitioners 7
-
Michelle Allore, NP
-
Ashwin Sam Koshy, DO
-
Rayford Benard Mitchell, M.D.
-
Paul Turner, FNP
-
Karah Wiatrek, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040420001663 | TX | Part B Supplier - Clinic/Group Practice | 3779579412 |
Receives reassigned benefits from 25 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Poteet, TX; Three Rivers, TX; Tilden, TX; Lytle, TX; Karnes City, TX; Floresville, TX; Pleasanton, TX |
National Provider Directory
- Part of
- Atascosa Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
105 E. Thornton
Three Rivers, TX 78071
Mailing address
310 W Oaklawn Rd
Pleasanton, TX 78064-4033
Phone (830) 569-8940
Other names
- Live Oak Community Health Center
Other providers in Three Rivers, TX
- Atascosa Health Center, Inc.
- Bird Management 1952, LLC
- Linlee Elizabeth Carbajal
- Rachel R Dockery
- Holly Christine Elzey
All providers in Three Rivers, 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 11, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.