MEDICARE: CLINICA EMMANUEL NINOS Y ADULTOS LLC

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

General Provider Information

NPI Number	:	1881048049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA EMMANUEL NINOS Y ADULTOS LLC

Provider Business Mailing Address
First Line	:	PO BOX 787
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-0013
Country	:	US
Telephone Number	:	956-580-9071
Fax Number	:	956-580-9087

Provider Business Practice Location Address
First Line	:	9927 STATE HIGHWAY 107
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-7860
Country	:	US
Telephone Number	:	956-580-9071
Fax Number	:	956-580-9087

Authorized Official
Title or Position	:	OWNER
Name	:	AGUSTIN B MEGO
Credential	:	MD
Telephone Number	:	956-580-9071

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	08/21/2024

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