=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801544663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARR FAMILY MEDICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2022
-----------------------------------------------------
Last Update Date | 03/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 E EDINBURG AVE
-----------------------------------------------------
City | ELSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78543-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-262-9661
-----------------------------------------------------
Fax | 956-262-9664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3106 E INGLE RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78542-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-262-9661
-----------------------------------------------------
Fax | 956-262-9664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MEMBER
-----------------------------------------------------
Name | MR. SALVADOR ARELLANO JR.
-----------------------------------------------------
Credential | PHYSICIAN ASSISTANT
-----------------------------------------------------
Telephone | 956-207-4816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------