NPIMap

Organization Active NPI

Pediatric Specialty Rural Health Clinic,LTD

  • Clinic/Center
  • Eagle Pass, TX
National Provider Identifier
1851486500
Registry record updated Nov 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
F3442 Issued in TX
Legal business name
PEDIATRIC SPECIALTY RURAL HEALTH CLINIC,LTD
Practice address
710 Williams St
Eagle Pass, TX 78852-5126
Phone
(830) 773-1103
Fax
(830) 757-8366
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2010

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

Authorized official

Name
Mrs. Debra W De Los Santos
Title
Ceo
Phone
(830) 773-1103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X F3442 TX Primary

Addresses

Primary practice location

710 Williams St
Eagle Pass, TX 78852-5126

Mailing address

PO Box 2368
Eagle Pass, TX 78853-2368
Phone (830) 773-1103

Other identifiers 3

IdentifierTypeStateIssuer
130941102OtherTXDR.RICARDO DE LOS SANTOS
742708192OtherTXTAX ID
8127J1OtherTXBLUECROSSBLUESHIELD

Other names 1

  • d/b/a Eagle Pass Pediatric Health Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1851486500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2368",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788532368",
            "telephone_number": "830-773-1103",
            "fax_number": "830-757-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 WILLIAMS ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525126",
            "telephone_number": "830-773-1103",
            "fax_number": "830-757-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPECIALTY RURAL HEALTH CLINIC,LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "DE LOS SANTOS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-773-1103",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "F3442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR.RICARDO DE LOS SANTOS",
            "identifier": "130941102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "742708192",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "8127J1",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a Eagle Pass Pediatric Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle Pass, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; 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.