NPIMap

Organization Active NPI

Su Clinica Familiar

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, TX
National Provider Identifier
1386960862
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SU CLINICA FAMILIAR
Practice address
Hwy 107 and la Feria Avenue
Santa Rosa, TX 78593-0226
Phone
(956) 365-6071
Fax
(956) 365-6072
NPI assigned
Apr 9, 2010
Last updated
Mar 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
Mr. Adam Saldivar
Title
Cfo
Phone
(956) 365-9750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

Hwy 107 and la Feria Avenue
Santa Rosa, TX 78593-0226

Mailing address

1706 Treasure Hills Blvd
Harlingen, TX 78550-8911
Phone (956) 365-6750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101116000008 TX Part A Provider - Federally Qualified Health Center (FQHC) 5496663429 Practice locations: Santa Rosa, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386960862. Details of each certification follow.

Federally qualified health center certification: CCN 671951

Legal name
SU CLINICA FAMILIAR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 19, 2010
Last certification
Nov 19, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 1, 1971 in TX
Enrollment address
Hwy 107 and la Feria Avenue
Santa Rosa, TX 78593-0226

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Suclinica Familiar15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jose Adam Saldivar Individual Corporate OfficerChief Financial Officer Dec 12, 2005
W-2 Managing Employee Jul 1, 2010
Su Clinica Familiar Organization, Harlingen, TX Operational/Managerial Control Jul 1, 2010

Owners & managing parties with NPI records 4

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

NPI Registry JSON

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

{
    "created_epoch": "1270771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1386960862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 TREASURE HILLS BLVD",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785508911",
            "telephone_number": "956-365-6750",
            "fax_number": "956-365-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 107 AND LA FERIA AVENUE",
            "city": "SANTA ROSA",
            "state": "TX",
            "postal_code": "785930226",
            "telephone_number": "956-365-6071",
            "fax_number": "956-365-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SU CLINICA FAMILIAR",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-09",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "SALDIVAR",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "956-365-9750",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, TX

Sources for this page

Verify at the official NPI Registry.