Centro Medico Familiar Ebenezer

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

AP 124023 Issued in TX

Legal business name

CENTRO MEDICO FAMILIAR EBENEZER

Practice address

5650 N Foster Rd
San Antonio, TX 78244-1106

Phone

(210) 997-0103

Fax

(210) 375-6148

NPI assigned

Nov 27, 2015

Organization subpart

No

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

Authorized official

Name

Carlos Alberto Cosme-Thillet, NP

Title

Owner/NP

Phone

(210) 997-0103

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1448582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448582400000",
    "number": "1841664067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8212 HEIGHTS VLY",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781093502",
            "telephone_number": "210-709-8760",
            "fax_number": "210-375-6148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5650 N FOSTER RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782441106",
            "telephone_number": "210-997-0103",
            "fax_number": "210-375-6148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO MEDICO FAMILIAR EBENEZER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-27",
        "last_updated": "2015-11-27",
        "status": "A",
        "authorized_official_last_name": "COSME-THILLET",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "ALBERTO",
        "authorized_official_title_or_position": "OWNER/NP",
        "authorized_official_telephone_number": "210-997-0103",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "AP 124023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.