MEDICARE: BORDER CLINIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	222798	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222798	OTHER	NC	NC LICENSE

General Provider Information

NPI Number	:	1871088245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDER CLINIC, PA

Provider Business Mailing Address
First Line	:	2721 HORSE PEN CREEK RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8387
Country	:	US
Telephone Number	:	956-727-3047
Fax Number	:	956-717-3630

Provider Business Practice Location Address
First Line	:	2721 HORSE PEN CREEK RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8387
Country	:	US
Telephone Number	:	956-727-3047
Fax Number	:	956-717-3630

Authorized Official
Title or Position	:	CEO
Name	:	CLAUDIA G MERCADO
Credential	:	MD
Telephone Number	:	956-727-3047

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	09/01/2022

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Directions to “BORDER CLINIC, PA ” Practice Location

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