=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205368602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES NICHOLAS FAHEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2017
-----------------------------------------------------
Last Update Date | 07/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3804 S JACKSON RD STE 2
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-6683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-296-3021
-----------------------------------------------------
Fax | 956-296-3020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2102 TREASURE HILLS BLVD # 3.14406
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-8736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-296-1437
-----------------------------------------------------
Fax | 956-296-6842
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | S4465
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------