Provider Demographics
NPI:1043302334
Name:JAVIER MEDINA MD PA
Entity Type:Organization
Organization Name:JAVIER MEDINA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-581-5100
Mailing Address - Street 1:PO BOX 5909
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5909
Mailing Address - Country:US
Mailing Address - Phone:956-581-5100
Mailing Address - Fax:956-581-8608
Practice Address - Street 1:1924 E GRIFFIN PARKWAY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-581-5100
Practice Address - Fax:956-581-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7088207Q00000X
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111655001Medicaid
TN189269701Medicaid
TX189269702Medicaid
TX00X088Medicare PIN
TXF92895Medicare UPIN