Provider Demographics
NPI:1336816230
Name:HEART OF GOLD PRIMARY CARE SVCS
Entity type:Organization
Organization Name:HEART OF GOLD PRIMARY CARE SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-676-9472
Mailing Address - Street 1:517 ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-2218
Mailing Address - Country:US
Mailing Address - Phone:956-420-2178
Mailing Address - Fax:
Practice Address - Street 1:517 ROBIN ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78595-2218
Practice Address - Country:US
Practice Address - Phone:956-420-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle