Provider Demographics
NPI:1083926737
Name:ADVANCED VEIN CARE CLINIC
Entity Type:Organization
Organization Name:ADVANCED VEIN CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-648-8035
Mailing Address - Street 1:PO BOX 5550
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5550
Mailing Address - Country:US
Mailing Address - Phone:956-627-3686
Mailing Address - Fax:956-664-0531
Practice Address - Street 1:5015 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8080
Practice Address - Country:US
Practice Address - Phone:956-627-3686
Practice Address - Fax:956-664-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7519208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220218601Medicaid
TX163901506OtherCSHCN MEDICAID
TXDR2134OtherRR MEDICARE
TXTXB109452Medicare PIN