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General NPI Number Information
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NPI Number | 1205101417
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Entity Type | Organization
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Legal Business Name | THE CLINIC AT THE PORT
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 3150 N. INDIANA AVE
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City | BROWNSVILLE
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State | TX
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Zip | 78526
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Country | US
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Telephone | 956-831-3400
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1822
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City | LOS FRESNOS
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State | TX
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Zip | 78566
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Country | US
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Telephone | 956-831-3400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LAHOMA MAE PEDERSON
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Credential |
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Telephone | 956-551-6742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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