MEDICARE: DR. MANUEL R CARRASCO-SANTIAGO MD

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	207R00000X	Internal Medicine Physician	J5275	TX
2	283Q00000X	Psychiatric Hospital	J5275	TX

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	:	1932109196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL R CARRASCO-SANTIAGO MD

Provider Business Mailing Address
First Line	:	1501 W 11TH PL
Second Line	:	SUITE # 304
City	:	BIG SPRING
State	:	TX
Zip	:	79720-4119
Country	:	US
Telephone Number	:	432-714-4500
Fax Number	:	432-714-4502

Provider Business Practice Location Address
First Line	:	1501 W 11TH PL
Second Line	:	SUITE # 304
City	:	BIG SPRING
State	:	TX
Zip	:	79720-4119
Country	:	US
Telephone Number	:	432-714-4500
Fax Number	:	432-714-4502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/29/2014

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Directions to “ DR. MANUEL R CARRASCO-SANTIAGO MD” Practice Location

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