Provider Demographics
NPI:1336284785
Name:UNITED MEDICAL CENTERS
Entity type:Organization
Organization Name:UNITED MEDICAL CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:830-773-8917
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:202 JAMES ST
Practice Address - Street 2:
Practice Address - City:BRACKETTVILLE
Practice Address - State:TX
Practice Address - Zip Code:78832-0729
Practice Address - Country:US
Practice Address - Phone:830-563-2434
Practice Address - Fax:855-729-6740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 207Y00000X, 208000000X, 208D00000X, 363A00000X, 363L00000X, 363LP0200X, 363LW0102X, 101YM0800X, 207Q00000X, 207R00000X, 207RI0011X
TX213E00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137809306 (FQHC SITEMedicaid
TX137809302 (GROUPALL)Medicaid
TX137809306 (FQHC SITEMedicaid
TX137809302 (GROUPALL)Medicaid
TXCP7072 (RAILROAD)Medicare PIN
TX00FC58Medicare ID - Type UnspecifiedMEDICARE TRAILBLAZER
TX217985501OtherLEE T. KEENEN, DPM
TX138165936OtherPALANI S. MANI, MD
TX1104976539OtherJUAN SAUCEDO DO
TX137809306Medicaid
TX1740312867OtherAURELIO LAING III MD
TX131765305OtherJUAN SAUCEDO,DO OB
TXCP7072Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX1003963984OtherAGUSTIN Q LUZ MD
TX451854Medicare ID - Type UnspecifiedMEDICARE UGS