KICKAPOO TRADITIONAL TRIBE OF TEXAS NPI 1821159518

NPI Information

NPI: 1821159518
Provider Name: KICKAPOO TRADITIONAL TRIBE OF TEXAS

Former Legal Business Name: TEXAS BAND OF KICKAPOO

Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

CLIA Number: 45D2087711

Address:
2192 ROSITA VALLEY ROAD
EAGLE PASS, TX
ZIP 78852
Phone: (830) 421-5349
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KICKAPOO TRADITIONAL TRIBE OF TEXAS is a health service clinic center in Eagle Pass, TX. KICKAPOO TRADITIONAL TRIBE OF TEXAS NPI is 1821159518. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Texas Band Of Kickapoo.

The provider's business location address is:

2192 ROSITA VALLEY ROAD
EAGLE PASS, TX
ZIP 78852-752
Phone: (830) 421-5349
Fax: (830) 757-5193

The provider's authorized official is Juanita Elizondo .
The authorized official title is Office Manager and has the following contact phone number (830) 421-5903.

The CLIA number assigned to this NPI record is 45D2087711 - other - tribal health facility with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/13/2006 and was last updated on 3/14/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	HSZ222	OTHER	TEXAS	MEDICARE
2	200158801	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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