Provider Demographics
NPI:1194772186
Name:FORT DUNCAN MEDICAL CENTER, L.P.
Entity type:Organization
Organization Name:FORT DUNCAN MEDICAL CENTER, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ONTIVEROS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-773-5321
Mailing Address - Street 1:350 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5110
Mailing Address - Country:US
Mailing Address - Phone:830-773-5321
Mailing Address - Fax:830-758-4872
Practice Address - Street 1:350 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5110
Practice Address - Country:US
Practice Address - Phone:830-773-5321
Practice Address - Fax:830-758-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX722994133NN1002X
TX000547146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
Not Answered146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00120RMedicare ID - Type UnspecifiedFDMC ER PHYSICIAN GROUP
TX00129RMedicare ID - Type UnspecifiedFDMC CRNA GROUP