NPIMap

Organization Active NPI

Family Medical and Specialty Clinic LLP

  • Rural Health Clinic/Center
  • Rio Grande City, TX
National Provider Identifier
1447274048
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY MEDICAL AND SPECIALTY CLINIC LLP
Practice address
2790 Pharmacy Rd Ste B
Rio Grande City, TX 78582-6547
Phone
(956) 487-7561
Fax
(956) 487-0097
NPI assigned
Jul 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Authorized official

Name
Mrs. Eva Hernandez
Title
Office Manager
Phone
(956) 487-7561

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2790 Pharmacy Rd Ste B
Rio Grande City, TX 78582-6547

Mailing address

2790 Pharmacy Rd Ste B
Rio Grande City, TX 78582-6547
Phone (956) 487-7561

Other identifiers 1

IdentifierTypeStateIssuer
107763801MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040930001187 TX Part B Supplier - Clinic/Group Practice 0547239055 Receives reassigned benefits from 6 practitioners
Practice locations: Rio Grande City, TX
O20080102000092 TX Part A Provider - Rural Health Clinic 0547239055 Practice locations: Rio Grande City, TX

Rural health clinic certification: CCN 453849

Legal name
FAMILY MEDICAL AND SPECIALTY CLINIC LLP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 12, 1992
Last certification
May 13, 2015
Ownership / control type
2A
Organization structure
PartnershipProprietary
Enrollment address
2790 Pharmacy Rd
Ste B
Rio Grande City, TX 78582-6547

National Provider Directory

National Provider Directory

Locations

2790 Pharmacy Rd
Ste B
Rio Grande Cy, TX 78582
Phone (956) 487-7561

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 a Vazquez Individual General Partnership Interest Apr 1, 2007
Julia Edith Vazquez Individual W-2 Managing EmployeeAdministrator, Clinical Director Jun 6, 2023 50%
Operational/Managerial ControlAdministrator/ Clinical Director Jun 6, 2023 50%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1447274048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 PHARMACY RD STE B",
            "city": "RIO GRANDE CITY",
            "state": "TX",
            "postal_code": "785826547",
            "telephone_number": "956-487-7561",
            "fax_number": "956-487-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 PHARMACY RD STE B",
            "city": "RIO GRANDE CITY",
            "state": "TX",
            "postal_code": "785826547",
            "telephone_number": "956-487-7561",
            "fax_number": "956-487-0097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL AND SPECIALTY CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-09-13",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "EVA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "956-487-7561",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107763801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Grande City, TX

Sources for this page

Verify at the official NPI Registry.