Eduardo Moreno, M.D., Rural Health Clinic, LLP

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

EDUARDO MORENO, M.D., RURAL HEALTH CLINIC, LLP

Practice address

210 S Avenue C
Crystal City, TX 78839-3834

Phone

(830) 374-2952

Fax

(830) 374-3784

NPI assigned

Oct 18, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Helen E Moreno

Title

Clinic Administrator

Phone

(210) 497-4272

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Helen E Moreno Former legal business name

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 453832

Legal name

EDUARDO MORENO, M.D., RURAL HEALTH CLINIC, LLP

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 10, 1991

Last certification

Jul 6, 2022

Ownership / control type

1C

Organization structure

LLCProprietary

Incorporated

Jun 24, 2010 in TX

Enrollment address

210 S Avenue C
Crystal City, TX 78839-3834

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Eduardo P Moreno, M.D.

  • Family Medicine Physician
  • Crystal City, TX
  • NPI 1629140306

  Corporate Director, General Partnership Interest

  CMS ownership

Practitioners 2

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

• Roland F Mena, PA-C

  • Physician Assistant
  • San Antonio, TX
  • NPI 1083645964
  Medicare reassignment
• Shirley Koehler, PA-C

  • Medical Physician Assistant
  • Crystal City, TX
  • NPI 1689761363
  NPD (past)

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1376732099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S AVENUE C",
            "address_2": "P.O. BOX 725",
            "city": "CRYSTAL CITY",
            "state": "TX",
            "postal_code": "788393834",
            "telephone_number": "830-374-2952",
            "fax_number": "830-374-3784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S AVENUE C",
            "city": "CRYSTAL CITY",
            "state": "TX",
            "postal_code": "788393834",
            "telephone_number": "830-374-2952",
            "fax_number": "830-374-3784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDUARDO MORENO, M.D., RURAL HEALTH CLINIC, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "HELEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "210-497-4272",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "E3738",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "00BT71",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063386901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Helen E Moreno",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Helen E Moreno",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Sarah L. Gibbons, CPNP

• Rural Health Clinic/Center in Crystal City, TX
• Providers in Crystal City, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.