Provider Demographics
NPI:1891525127
Name:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Entity type:Organization
Organization Name:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-548-7400
Mailing Address - Street 1:191 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3527
Mailing Address - Country:US
Mailing Address - Phone:956-548-7400
Mailing Address - Fax:
Practice Address - Street 1:723 SANTA ISABEL BLVD STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578-2647
Practice Address - Country:US
Practice Address - Phone:956-548-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)