1912182577 NPI number — DR LUIS M RIOS M D P A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912182577 NPI number — DR LUIS M RIOS M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR LUIS M RIOS M D P A
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:
6
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:
1912182577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 CORNERSTONE BLVD
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:
78539-8301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-682-3147
Provider Business Mailing Address Fax Number:
956-682-3511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 CORNERSTONE BLVD
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:
78539-8301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-682-3147
Provider Business Practice Location Address Fax Number:
956-682-3511
Provider Enumeration Date:
01/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RIOS
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-682-3147

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  J0221 , 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: 152179101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031479101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00701R . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0059GS . This is a "BLUE CROSS/BLUE SHIELD GR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8B6021 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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