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Su Clinica Familiar

Organization Active NPI Federally Qualified Health Center (FQHC) · Raymondville, TX

NPI 1871516807 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1871516807
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SU CLINICA FAMILIAR
Practice address
131 FM 3168
Raymondville, TX 78580-3605
Phone
(956) 689-2196
Fax
(956) 689-5937
NPI assigned
Jul 25, 2006
Organization subpart
No

Authorized official

Name
Mr. Adam Saldivar
Title
Cfo
Phone
(956) 365-6750

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 14

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 24

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

Federally qualified health center certification: CCN 451830

Legal name
SU CLINICA FAMILIAR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 1, 1971 in TX
Enrollment address
131 FM 3168
Raymondville, TX 78580-3605

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jose Adam Saldivar
Individual 		Corporate Director Apr 19, 2007
Melida Villareal
Individual 		W-2 Managing Employee Apr 19, 2007
Elena L Marin
Individual 		Corporate Officer
Ceo		 Dec 10, 2003

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Su Clinica Familiar
Santa Rosa, TX · CCN 671951		 Federally qualified health center Operational/Managerial Control Jul 1, 2010

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031017000009 TX Part a Provider - Federally Qualified Health Center (FQHC) 5496663429 Practice locations: Raymondville, TX

National Provider Directory

Tax ID family
Suclinica Familiar (15 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

131 FM 3168
Raymondville, TX 78580-3605

Mailing address

1706 Treasure Hills Blvd
Harlingen, TX 78550-8911
Phone (956) 365-6750

Other providers in Raymondville, TX

All providers in Raymondville, TX · Federally Qualified Health Center (FQHC) in Texas

Sources for this page

Verify at the official NPI Registry.