=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265512271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIO GRANDE ANESTHESIOLOGISTS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 11/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1072 E LOS EBANOS BLVD
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-9988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-541-1278
-----------------------------------------------------
Fax | 956-541-2854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1072 E LOS EBANOS BLVD
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-9988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-541-1278
-----------------------------------------------------
Fax | 956-541-2854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GROUP ADMINISTRATOR
-----------------------------------------------------
Name | ART DELGADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-541-1278
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------