| NPI | 1104998749 |
|---|---|
| Doing Business As | CENTROMED SOUTHSIDE MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | CHUCK WALZEL CFO 210-334-3724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX HBOCS00758-04-00) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX HBOCS007758-04-00) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2011-08-18 |