Provider Demographics
NPI:1346056546
Name:AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Entity type:Organization
Organization Name:AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE AND COMPLIANCE COORD
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:ROCHELL
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-736-2577
Mailing Address - Street 1:1533 S BROWNLEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3131
Mailing Address - Country:US
Mailing Address - Phone:361-884-2242
Mailing Address - Fax:361-884-2243
Practice Address - Street 1:1711 W WHEELER AVE STE 3
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4565
Practice Address - Country:US
Practice Address - Phone:361-884-2242
Practice Address - Fax:361-884-2243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-04
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty