MEDICARE: MID-VALLEY DIAGNOSTICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1295472892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-VALLEY DIAGNOSTICS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1598
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78296-1598
Country	:	US
Telephone Number	:	956-973-5990
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 ANGELITA DR STE 4
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-4790
Country	:	US
Telephone Number	:	956-973-5990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES ZAREMBA
Credential	:	MD
Telephone Number	:	214-708-1173

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/17/2022

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