=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770723496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HMC PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2009
-----------------------------------------------------
Last Update Date | 02/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1595 W US HIGHWAY 77 STE D
-----------------------------------------------------
City | SAN BENITO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78586-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-456-2808
-----------------------------------------------------
Fax | 815-301-9393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1595 W US HIGHWAY 77 STE D
-----------------------------------------------------
City | SAN BENITO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78586-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-456-2808
-----------------------------------------------------
Fax | 815-301-9393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MANAGING MEMBER
-----------------------------------------------------
Name | HENRY FERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-456-2808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------