Provider Demographics
NPI:1053405167
Name:CUERO MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:CUERO MEDICAL ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-275-3466
Mailing Address - Street 1:2500 N ESPLANADE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-4723
Mailing Address - Country:US
Mailing Address - Phone:361-275-3466
Mailing Address - Fax:361-275-3460
Practice Address - Street 1:2500 N ESPLANADE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4723
Practice Address - Country:US
Practice Address - Phone:361-275-3466
Practice Address - Fax:361-275-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171548405Medicaid
TX171548404Medicaid
TX171548404Medicaid