=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265518914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANISLAUS NWAFOR UZOIGWE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E 2ND ST
-----------------------------------------------------
City | RIO GRANDE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78582-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-488-1200
-----------------------------------------------------
Fax | 956-488-9500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 E 2ND ST
-----------------------------------------------------
City | RIO GRANDE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78582-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-488-1200
-----------------------------------------------------
Fax | 956-488-9500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING CLERK
-----------------------------------------------------
Name | MS. ANA FALCON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-488-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | L4155
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------