Community Health Centers of South Central Texas, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Luling, TX
NPI 1396904686 · NPPES record last updated Sep 3, 2020
Key facts
- NPI
- 1396904686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC
- Practice address
- 111 S. Laurel Avenue
Luling, TX 78648-2624 - Phone
- (830) 875-6399
- Fax
- (830) 875-6398
- NPI assigned
- Jun 3, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL INC
Authorized official
- Name
- Rafael De la Paz
- Title
- Ceo
- Phone
- (830) 672-6511
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 5
Related certifications (CCN) 1
Practitioners 9
-
Ashley Rozier Davis, LPC
-
Sean Hattenbach, M.D.
-
Theodore N Held, M.D.
-
Debra Irwin, MD
-
John Mark Janes, MD
-
Roland A Medellin, M.D.
-
Lucia Ridlen-Gonzalez, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0975485 | Community Health Centers of South Central TX Inc | Provider-performed microscopy | Sep 9, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Federally qualified health center certification: CCN 451925
- Legal name
- COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
- Doing business as
- LULING COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 16, 2000
- Last certification
- Aug 16, 2000
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 11, 1998 in TX
- Enrollment address
- 111 S Laurel Ave
Luling, TX 78648-2624 - Related CCNs
- 451814
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel Kleiner |
Corporate Director |
Sep 10, 2018 | |
| Dorothy Eberle |
Corporate Director |
Jan 1, 2010 | |
| Lisa Burns |
Corporate Director |
Apr 22, 2013 | |
| Rafael Delapaz |
Corporate Officer |
Jan 1, 2019 | |
| W-2 Managing Employee |
Oct 5, 2009 | ||
| Rosie Flores |
Corporate Director |
Jan 1, 2010 | |
| Charlie Patterson |
Corporate Director |
Sep 1, 2013 | |
| Raziel Delabarreda |
Corporate Officer |
Jun 1, 2019 | |
| Gary Clack |
Corporate Director |
Jan 25, 2022 | |
| Phillip Borowitz |
Corporate Director |
Jan 18, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100803001361 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 4688650328 | Practice locations: Luling, TX |
National Provider Directory
- Tax ID family
- Community Health Centers of
- Part of
- Community Health Centers of
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ADHCDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Family Planning Facility | 261QA0005X | |||
| Non-Surgical Family Planning Clinic/Center | 261QF0050X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
111 S. Laurel Avenue
Luling, TX 78648-2624
Mailing address
PO Box 1890
Gonzales, TX 78629-1390
Phone (830) 672-6511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 083010101 | Medicaid | TX | |
| 00HE62 | Other | TX | BLUE CROSS BLUE SHIELD |
| 121440502 | Medicaid | TX | |
| 121440505 | Medicaid | TX |
Other names
- Luling Community Health Center
Other providers in Luling, TX
- Central Texas Hospital Physicians PLLC
- Christine M Hervas DDS PA
- James P Chudleigh Jr.
- City of Luling
- CN Healthcare Providers, Inc.
- Dewitt Medical District
- Dismukesrx LLC
- Dismukesrx LLC
- Diversicare Leasing Corp.
- Duong and Associates PA
All providers in Luling, 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 Sep 3, 2020. 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.