=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720054406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCALLEN BONE & JOINT CLINIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 07/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 N 2ND ST STE A COL ROWE BLVD
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-618-4414
-----------------------------------------------------
Fax | 956-630-4136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1421 N 2ND ST STE A COL ROWE BLVD
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-618-4414
-----------------------------------------------------
Fax | 956-630-4136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MIGUEL A HERNANDEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-618-4414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------