Provider Demographics
NPI:1538218458
Name:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Entity type:Organization
Organization Name:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:95 E PRICE RD
Mailing Address - Street 2:BLDG D
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3578
Mailing Address - Country:US
Mailing Address - Phone:956-546-3209
Mailing Address - Fax:956-544-8120
Practice Address - Street 1:95 E PRICE RD
Practice Address - Street 2:BLDG D
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3578
Practice Address - Country:US
Practice Address - Phone:956-546-3209
Practice Address - Fax:956-544-8120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWNSVILLE COMMUNITY HEALTH CLINIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451970Medicare Oscar/Certification