1265155931 NPI number — RGV INSTITUTE OF PAIN MANAGEMENT LLC

Table of content: (NPI 1265155931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265155931 NPI number — RGV INSTITUTE OF PAIN MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RGV INSTITUTE OF PAIN MANAGEMENT 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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1265155931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1506 LONE STAR WAY STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-944-7194
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 S LONE STAR WAY STE 1
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:
78539-4977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-731-0409
Provider Business Practice Location Address Fax Number:
956-322-4092
Provider Enumeration Date:
09/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
MAURICIO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
361-944-7194

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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