Provider Demographics
NPI:1114652575
Name:CLINIC ON WHEELZ LLC
Entity Type:Organization
Organization Name:CLINIC ON WHEELZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-461-2766
Mailing Address - Street 1:1400 N BEDELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-7812
Mailing Address - Country:US
Mailing Address - Phone:915-519-7074
Mailing Address - Fax:
Practice Address - Street 1:1400 N BEDELL AVE STE B
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-7812
Practice Address - Country:US
Practice Address - Phone:915-519-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447847702OtherBOARD OF NURSING
TX1295269298OtherBOARD OF NURSING
TX1730850587OtherBOARD OF NURSING
TX1740312867OtherTEXAS MEDICAL BOARD