Provider Demographics
| NPI: | 1992840409 |
|---|---|
| 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: | 913 S MAIN ST |
| Practice Address - Street 2: | |
| Practice Address - City: | DEL RIO |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78840-5807 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 830-774-5534 |
| Practice Address - Fax: | 830-774-0890 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | UNITED MEDICAL CENTERS |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-02-21 |
| Last Update Date: | 2024-09-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 152W00000X, 207RI0011X, 207V00000X, 208000000X, 208D00000X, 363A00000X, 363L00000X, 363LF0000X, 363LP0200X, 363LW0102X | ||
| TX | 207Q00000X, 207R00000X, 213E00000X, 261QF0400X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 137809308 FQHC.SITE | Medicaid | |
| TX | 137809302 (GROUPALL) | Medicaid | |
| TX | 00FC58 (GROUP-ALL) | Medicare PIN | |
| TX | 137809302 (GROUPALL) | Medicaid | |
| TX | 451855 (FQHC SITE) | Medicare PIN | |
| TX | 138165936 | Other | PALANI S. MANI, MD |
| TX | CP7072 | Medicare ID - Type Unspecified | RAILROAD MEDICARE |
| TX | 00FC58 | Medicare ID - Type Unspecified | MEDICARE TRAILBLAZER |
| TX | FQS000334 | Other | DANIEL CHARTRAND, MD |
| TX | 207820601 | Other | AURELIO LAING III,MD |
| TX | 137809302 | Other | MEDICAID FFS |
| TX | 166954102 | Other | GERARDO ASTUDILLO, MD OBGYN |
| TX | 136715312 | Other | ANGEL MARTINEZ,MD |
| TX | 184988702 | Other | WENDY Y PITT,MD |
| TX | 137809308 | Medicaid | |
| TX | 217985501 | Other | LEE T. KEENEN, DPM |
| TX | TXB139630 | Other | JAMES H. FOWLER (INDIVIDUAL MEDICARE PTAN #) |
| TX | 1063474609 | Other | PALANI SUDRA MANI MD |
| TX | 131893305 | Other | MANUEL FRAUSTO,MD |
| TX | 1821085176 | Other | ANGEL MARTINEZ MD |
| TX | 137809302 | Other | MEDICAID FFS |
| TX | 1558555052 | Other | LEE THOMAS KEENEN JR DPM |
| TX | 1740312867 | Other | AURELIO LAING III MD |
| TX | 1841347838 | Other | WENDY PITT, MD |
| TX | 1891839098 | Other | DANIEL JOSEPH CHARTRAND MD |
| TX | 137809308 | Medicaid |
