=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538291406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARLINGEN WOMEN'S HEALTH CLINIC L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 PEASE ST SUITE 3D
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-8348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-428-6601
-----------------------------------------------------
Fax | 956-412-3352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 PEASE ST SUITE 3D
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-8348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-428-6601
-----------------------------------------------------
Fax | 956-412-3352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DR. HENRY ANTHONY BENAVIDES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 956-428-6601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | G7996
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------