1215066121 NPI number — VALLEY CHILDREN'S CLINIC, PA

Table of content: (NPI 1215066121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215066121 NPI number — VALLEY CHILDREN'S CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CHILDREN'S CLINIC, PA
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:
1215066121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2226 HAINE DR
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:
78550-8549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-423-1283
Provider Business Mailing Address Fax Number:
956-412-3033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2226 HAINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-423-1283
Provider Business Practice Location Address Fax Number:
956-412-3033
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAUCEDA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-423-1283

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 092695803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187365506 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187365508 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 092695805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187365509 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 092695806 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187365507 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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