Provider Demographics
NPI:1285066779
Name:CHAMPION PRIMARY CARE INC
Entity type:Organization
Organization Name:CHAMPION PRIMARY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-857-7086
Mailing Address - Street 1:116 MICHOACAN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6633
Mailing Address - Country:US
Mailing Address - Phone:956-735-7837
Mailing Address - Fax:956-583-4621
Practice Address - Street 1:116 MICHOACAN LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6633
Practice Address - Country:US
Practice Address - Phone:956-735-7837
Practice Address - Fax:956-583-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health