Healthcare Provider Details

I. General information

NPI: 1255915971
Provider Name (Legal Business Name): STANDARD MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 05/09/2021
Certification Date: 05/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MCPHERSON RD
LAREDO TX
78045-6268
US

IV. Provider business mailing address

10700 MCPHERSON RD
LAREDO TX
78045-6268
US

V. Phone/Fax

Practice location:
  • Phone: 956-523-2673
  • Fax: 855-952-2002
Mailing address:
  • Phone: 956-523-2673
  • Fax: 855-952-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN HUNTSINGER
Title or Position: CEO
Credential: MD
Phone: 210-859-7819