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General NPI Number Information
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NPI Number | 1386648798
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Entity Type | Organization
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Legal Business Name | VALLEY EAR NOSE & THROAT SPECIALIST PA
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 2101 S CYNTHIA ST
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City | MCALLEN
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State | TX
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Zip | 78503-1294
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Country | US
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Telephone | 956-687-7896
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Fax | 956-994-9694
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Provider Business Mailing Address
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Address Line | 2101 S CYNTHIA ST
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City | MCALLEN
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State | TX
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Zip | 78503-1294
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Country | US
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Telephone | 956-687-7896
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Fax | 956-994-9694
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Authorized Official
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Title or Position | PARTNER/OFFICER
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Name | CHARLES THEIVAGT
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Credential | MD
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Telephone | 956-687-7896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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