1114266525 NPI number — PERFORMANCE THERAPEUTICS - EAGLE PASS, PLLC

Table of content: (NPI 1114266525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114266525 NPI number — PERFORMANCE THERAPEUTICS - EAGLE PASS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE THERAPEUTICS - EAGLE PASS, PLLC
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:
1114266525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 LINDBERG 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:
78501-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-687-4559
Provider Business Mailing Address Fax Number:
956-687-4554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2483 2ND ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EAGLE PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78852-4390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-776-5181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CANALES
Authorized Official First Name:
EDWAR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
956-687-4559

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  671310001 , 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)





Copyright © 2007-2024 www.npivalidator.com