MEDICARE: MERCED FAMILY HEALTH CLINIC

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	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306843347	OTHER	TX	JRL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1639137193	OTHER	TX	DOC NPI

General Provider Information

NPI Number	:	1659974657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCED FAMILY HEALTH CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 3371
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-0057
Country	:	US
Telephone Number	:	956-225-2625
Fax Number	:	956-598-6069

Provider Business Practice Location Address
First Line	:	202 PALMVIEW DR STE 1
Second Line	:
City	:	PALMVIEW
State	:	TX
Zip	:	78572-9394
Country	:	US
Telephone Number	:	956-225-2625
Fax Number	:	956-598-6069

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JUAN R LLANES
Credential	:	APRN,FNP-BC
Telephone Number	:	956-225-2625

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	12/15/2020

Similar Medicare Providers

1306843347 — MR. JUAN ROBERTO LLANES MSN, APRN FNP-BC
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1962954081 — GABRIEL GUTIERREZ LCDC
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1912459843 — CHARLES BREWSTER LCDC
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1568414761 — ACE MEDICAL EQUIPMENT AND SUPPLIES
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Directions to “MERCED FAMILY HEALTH CLINIC ” Practice Location

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