1508070038 NPI number — LUIS DELGADO JR MD PA

Table of content: (NPI 1508070038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508070038 NPI number — LUIS DELGADO JR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUIS DELGADO JR 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:
NORTHSIDE FAMILY MEDICAL CENTER
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:
1508070038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5128 N 10TH ST
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:
78504-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-631-3831
Provider Business Mailing Address Fax Number:
956-618-5140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5128 N 10TH ST
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:
78504-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-631-3831
Provider Business Practice Location Address Fax Number:
956-631-5537
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
956-631-3831

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H4279 , 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: 217464101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111744202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111744204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 217464102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DR8589 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111744203 . This is a "MEDICAID EPSDT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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