| Brazos Valley Community Action Agency, Inc. | |
|
623 W Lassater Centerville TX 75833-1959 | |
| (903) 536-3687 | |
| (903) 536-7723 |
| Full Name | Brazos Valley Community Action Agency, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 623 W Lassater, Centerville, Texas |
| Authorized Official Name and Position | Theresa Sabella (CEO) |
| Authorized Official Contact | 9793832340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brazos Valley Community Action Agency, Inc. 1500 University Dr E College Station TX 77840-2600 Ph: (979) 383-2340 | Brazos Valley Community Action Agency, Inc. 623 W Lassater Centerville TX 75833-1959 Ph: (903) 536-3687 |
| NPI Number | 1568519122 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 09/11/2024 |
| Medicare PECOS PAC ID | 4284542127 |
|---|---|
| Medicare Enrollment ID | O20070118000343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568519122 | NPI | - | NPPES |
| 000951606 | Medicaid | TX | |
| 185649401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
St. Joseph Regional Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 West Main St., Centerville, TX 75833 Phone: 903-536-2313 Fax: 903-536-2207 |