1043302334 NPI number — JAVIER MEDINA MD PA

Table of content: (NPI 1043302334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043302334 NPI number — JAVIER MEDINA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAVIER MEDINA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043302334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-581-5100
Provider Business Mailing Address Fax Number:
956-581-8608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1924 E GRIFFIN PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-581-5100
Provider Business Practice Location Address Fax Number:
956-581-8608
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAENZ
Authorized Official First Name:
ADALIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECIALIST
Authorized Official Telephone Number:
956-581-5100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J7088 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111655001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189269701 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189269702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".