1437436151 NPI number — COLUMBIA RIO GRANDE HEALTHCARE LP

Table of content: (NPI 1437436151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437436151 NPI number — COLUMBIA RIO GRANDE HEALTHCARE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA RIO GRANDE HEALTHCARE LP
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:
RIO GRANDE WOMEN'S CLINIC
Provider Other Organization Name Type Code:
3
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:
1437436151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 E RIDGE RD
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78503-1251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-632-6032
Provider Business Mailing Address Fax Number:
956-971-9539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 E RIDGE RD
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-632-6032
Provider Business Practice Location Address Fax Number:
956-971-9539
Provider Enumeration Date:
11/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
956-632-6149

Provider Taxonomy Codes

  • Taxonomy code: 363LP1700X , with the licence number:  558605 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP1700X , with the licence number: 242863 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 234002 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 625642 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0883035 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3119380 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0707945 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1127169 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1711186 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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