Provider Demographics
NPI:1912733817
Name:UNITED MEDICAL CENTERS
Entity type:Organization
Organization Name:UNITED MEDICAL CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
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:
Practice Address - Street 1:3809 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2860
Practice Address - Country:US
Practice Address - Phone:830-488-6961
Practice Address - Fax:866-714-1737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-09
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1378093-02Medicaid