MEDICARE: SOUTH LAREDO FAMILY CLINIC PA

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578571451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LAREDO FAMILY CLINIC PA

Provider Business Mailing Address
First Line	:	PO BOX 451490
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045
Country	:	US
Telephone Number	:	956-722-5007
Fax Number	:	956-725-5894

Provider Business Practice Location Address
First Line	:	3527 JAIME ZAPATA MEMORIAL HWY
Second Line	:	SUITE 101
City	:	LAREDO
State	:	TX
Zip	:	78043-4788
Country	:	US
Telephone Number	:	956-722-5007
Fax Number	:	956-725-5894

Authorized Official
Title or Position	:	MD
Name	:	MATEO REYES
Credential	:	MD
Telephone Number	:	956-722-5007

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	10/08/2024

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