1760819809 NPI number — ROMEO F MONTALVO JR MD PA

Table of content: (NPI 1760819809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760819809 NPI number — ROMEO F MONTALVO JR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMEO F MONTALVO 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:
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:
1760819809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
864 CENTRAL BLVD
Provider Second Line Business Mailing Address:
SUITE 2200
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78520-7551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-541-8334
Provider Business Mailing Address Fax Number:
956-541-9738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
864 CENTRAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 2200
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-7551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-541-8334
Provider Business Practice Location Address Fax Number:
956-541-9738
Provider Enumeration Date:
10/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MONTALVO
Authorized Official First Name:
ROMEO
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
956-541-8334

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  E4537 , 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: 00HT72 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 139506100 . This is a "VALLEY HEALTH PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 130462805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130462802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2319479 . This is a "AETNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116607 . This is a "SUPERIOR HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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