1740891936 NPI number — UNIVERSITY OF TEXAS RIO GRANDE VALLEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740891936 NPI number — UNIVERSITY OF TEXAS RIO GRANDE VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS RIO GRANDE VALLEY
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:
1740891936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2102 TREASURE HILLS BLVD # 3.14406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-8736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-296-1437
Provider Business Mailing Address Fax Number:
956-296-6842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 W SCHUNIOR ST BLDG 2.318
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78541-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-296-1731
Provider Business Practice Location Address Fax Number:
956-296-1730
Provider Enumeration Date:
08/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KROUSE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
HOBART
Authorized Official Title or Position:
EXEC. VICE PRESIDENT, HEALTH AFFAIR
Authorized Official Telephone Number:
956-296-1445

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45D2181340 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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