Healthcare Provider Details

I. General information

NPI: 1205113255
Provider Name (Legal Business Name): RECOVERY MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 PADRE BLVD
SOUTH PADRE ISLAND TX
78597-7327
US

IV. Provider business mailing address

PO BOX 2078
MCALLEN TX
78505-2078
US

V. Phone/Fax

Practice location:
  • Phone: 956-772-9200
  • Fax: 956-772-9201
Mailing address:
  • Phone: 956-800-4014
  • Fax: 956-800-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberJ7546
License Number StateTX

VIII. Authorized Official

Name: DR. ALEJANDRO DARIO KUDISCH
Title or Position: CEO/ PSYCHIATRIST
Credential: M.D.,D.F.A.P.A.
Phone: 956-687-3000