=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386766681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM R MCKENNA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1713 TREASURE HILLS BLVD 1B
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-8917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-425-9240
-----------------------------------------------------
Fax | 956-412-8575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6
-----------------------------------------------------
City | SAN BENITO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78586-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-425-9240
-----------------------------------------------------
Fax | 956-412-8575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. WILLIAM R MCKENNA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-425-9240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------