MEDICARE: RGV VASCULAR LABS LTD

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	293D00000X	Physiological Laboratory

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	470000276	OTHER	TX	RAILROAD MEDICARE

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
2	0029CC	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1689674319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RGV VASCULAR LABS LTD

Provider Business Mailing Address
First Line	:	1200 E RIDGE RD
Second Line	:	STE 10
City	:	MCALLEN
State	:	TX
Zip	:	78503-1527
Country	:	US
Telephone Number	:	956-686-2488
Fax Number	:	956-630-4964

Provider Business Practice Location Address
First Line	:	1200 E RIDGE RD
Second Line	:	STE 10
City	:	MCALLEN
State	:	TX
Zip	:	78503-1527
Country	:	US
Telephone Number	:	956-686-2488
Fax Number	:	956-630-4964

Authorized Official
Title or Position	:	TECHNICAL DIRECTOR
Name	:	MR. GERALD M MCCALL
Credential	:	RN RVT
Telephone Number	:	956-686-2488

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	01/06/2012

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Directions to “RGV VASCULAR LABS LTD ” Practice Location

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