NPIMap

Organization Active NPI

Project Vida Health Center

Doing business as Ernesto Serna Middle School

  • Federally Qualified Health Center (FQHC)
  • Socorro, TX
National Provider Identifier
1467923250
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PROJECT VIDA HEALTH CENTER
Doing business as
Ernesto Serna Middle School
Practice address
11471 Alameda Ave
Socorro, TX 79927-3239
Phone
(915) 537-7057
Fax
(915) 857-8971
NPI assigned
Dec 6, 2018
Last updated
Mar 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

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

Authorized official

Name
William David Schlesinger
Title
Ceo
Phone
(915) 533-7057

Specialties & licenses 1

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

Addresses

Primary practice location

11471 Alameda Ave
Socorro, TX 79927-3239

Mailing address

3607 Rivera Ave
El Paso, TX 79905-2415
Phone (915) 533-7057

Other names 1

  • ERNESTO SERNA MIDDLE SCHOOL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190617001942 TX Part A Provider - Federally Qualified Health Center (FQHC) 4486614765 Practice locations: Socorro, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467923250. Details of each certification follow.

Federally qualified health center certification: CCN 451064

Legal name
PROJECT VIDA HEALTH CENTER
Doing business as
ERNESTO SERENA MIDDLE SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 13, 2019
Last certification
Jun 13, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 30, 2003 in TX
Enrollment address
11471 Alameda Ave
Socorro, TX 79927-3239

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Project Vida Health Center38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Patrick Bramblett Individual Corporate DirectorBoard Chair Jan 1, 2018
Noelia Mendoza Individual Corporate DirectorBoard Secretary Oct 1, 2018
Steve M Wagner Individual Corporate DirectorBoard Member Jan 1, 2016
Jesus Gonzales Individual Corporate DirectorBoard Treasurer Jan 1, 2016
Nelson Ortega Individual Corporate DirectorVice Chair Aug 1, 2019
Timothy Davenport-Herbst Individual Corporate OfficerCeo Jan 1, 2025
Corporate DirectorCeo Jan 1, 2025
W-2 Managing EmployeeCeo Jan 1, 2025
Ira N Locke Individual Corporate DirectorBoard Member Jan 1, 2017
Luis Raul Garza Individual Corporate OfficerChief Medical Officer Jan 1, 2014
Daniel Calvo Individual Corporate DirectorBoard Member Sep 1, 2020
Lee Ann Bondurant Individual Corporate DirectorBoard Member Jan 1, 2015
Omar Carmona Individual Corporate DirectorBoard Member Sep 1, 2020
Ruben Iguaran Individual Corporate DirectorBoard Member Sep 1, 2020

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Montana Vista Health CenterEl Paso, TX, CCN 671927 Federally qualified health center Other Jan 1, 2022
Mountain View High SchoolEl Paso, TX, CCN 971003 Federally qualified health center Other Jan 1, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1467923250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3607 RIVERA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799052415",
            "telephone_number": "915-533-7057",
            "fax_number": "915-857-8971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11471 ALAMEDA AVE",
            "city": "SOCORRO",
            "state": "TX",
            "postal_code": "799273239",
            "telephone_number": "915-537-7057",
            "fax_number": "915-857-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROJECT VIDA HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-06",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "SCHLESINGER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "915-533-7057"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERNESTO SERNA MIDDLE SCHOOL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Socorro, TX

Sources for this page

Verify at the official NPI Registry.