Provider Demographics
NPI:1871516807
Name:SU CLINICA FAMILIAR
Entity type:Organization
Organization Name:SU CLINICA FAMILIAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-365-6750
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6750
Mailing Address - Fax:956-365-6779
Practice Address - Street 1:131 FM 3168
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3605
Practice Address - Country:US
Practice Address - Phone:956-689-2196
Practice Address - Fax:956-689-5937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451830Medicare ID - Type UnspecifiedMEDICARE FAC #