=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841200805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCALLEN ANESTHESIA CONSULTANTS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 09/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5501 S MCCOLL RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-9152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-661-0529
-----------------------------------------------------
Fax | 956-618-4639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3449
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78502-3449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-661-0529
-----------------------------------------------------
Fax | 956-618-4639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | IRENE LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-661-0529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | G6511
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------