1114130218 NPI number — LOWER RIO GRANDE VALLEY COMMUNITY HEALTH MANAGEMENT CORPORATION INC

Table of content: (NPI 1114130218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114130218 NPI number — LOWER RIO GRANDE VALLEY COMMUNITY HEALTH MANAGEMENT CORPORATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWER RIO GRANDE VALLEY COMMUNITY HEALTH MANAGEMENT CORPORATION INC
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:
1114130218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 E VERMONT AVE
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:
78503-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-213-6400
Provider Business Mailing Address Fax Number:
956-213-0692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 E VERMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-213-6400
Provider Business Practice Location Address Fax Number:
956-213-0692
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RESENDEZ
Authorized Official First Name:
MARISOL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
956-213-6410

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080028601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC0619 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0015BR . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".