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General NPI Number Information
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NPI Number | 1134448400
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Entity Type | Organization
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Legal Business Name | EDINBURG MULTI-SPECIALTY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 3226 W ALBERTA RD
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City | EDINBURG
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State | TX
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Zip | 78539-9635
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Country | US
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Telephone | 956-393-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 S MCCOLL RD SUITE B PMB226
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City | MCALLEN
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State | TX
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Zip | 78503-1501
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Country | US
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Telephone | 956-393-9998
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY J MCCOY
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Credential | RN
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Telephone | 956-393-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | J6969
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License Number State | TX
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