1275724882 NPI number — JORGE A ORTEGON MD PA

Table of content: (NPI 1275724882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275724882 NPI number — JORGE A ORTEGON MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGE A ORTEGON MD 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:
1275724882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4647
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:
78502-4647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-630-1225
Provider Business Mailing Address Fax Number:
956-630-1841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2821 MICHAEL ANGELO
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-630-1225
Provider Business Practice Location Address Fax Number:
956-630-1841
Provider Enumeration Date:
08/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
956-630-4155

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  K6668 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0079MN . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119496 . This is a "COMMERCIAL NETWORK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 135925100 . This is a "COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 172028601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8S0570 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 970007388 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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