1578974168 NPI number — MEDISERVE LLC

Table of content: (NPI 1578974168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578974168 NPI number — MEDISERVE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDISERVE LLC
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:
MEDISERVE LLC
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:
1578974168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 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:
78501-2913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-536-1277
Provider Business Mailing Address Fax Number:
956-682-7780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 LINDBERG 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:
78501-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-536-1277
Provider Business Practice Location Address Fax Number:
956-682-7780
Provider Enumeration Date:
05/16/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARBOSA
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
956-536-1277

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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