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General NPI Number Information
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NPI Number | 1255915971
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Entity Type | Organization
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Legal Business Name | STANDARD MEDICAL
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Dates
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Enumeration Date | 05/09/2021
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Last Update Date | 05/09/2021
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Provider Practice Location Address
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Address Line | 10700 MCPHERSON RD
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City | LAREDO
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State | TX
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Zip | 78045-6268
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Country | US
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Telephone | 956-523-2673
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Fax | 855-952-2002
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Provider Business Mailing Address
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Address Line | 10700 MCPHERSON RD
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City | LAREDO
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State | TX
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Zip | 78045-6268
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Country | US
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Telephone | 956-523-2673
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Fax | 855-952-2002
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN HUNTSINGER
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Credential | MD
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Telephone | 210-859-7819
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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 |
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License Number State |
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