Provider Demographics
NPI:1114051091
Name:RIO GRANDE MEDICINE, INC
Entity Type:Organization
Organization Name:RIO GRANDE MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAVINON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-421-2757
Mailing Address - Street 1:5505 S EXPRESSWAY 77 STE 205
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3222
Mailing Address - Country:US
Mailing Address - Phone:956-421-2757
Mailing Address - Fax:956-421-2787
Practice Address - Street 1:5505 S EXPRESSWAY 77 STE 205
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3222
Practice Address - Country:US
Practice Address - Phone:956-421-2757
Practice Address - Fax:956-421-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167926802Medicaid
TX0073LWOtherBCBS GROUP NUMBER
TX167926802Medicaid