Provider Demographics
NPI:1114964178
Name:COLUMBIA RIO GRANDE HEALTHCARE, L.P.
Entity Type:Organization
Organization Name:COLUMBIA RIO GRANDE HEALTHCARE, L.P.
Other - Org Name:RIO GRANDE REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-632-6101
Mailing Address - Street 1:101 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1248
Mailing Address - Country:US
Mailing Address - Phone:956-632-6000
Mailing Address - Fax:956-632-6621
Practice Address - Street 1:101 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1248
Practice Address - Country:US
Practice Address - Phone:956-632-6000
Practice Address - Fax:956-632-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112716901Medicaid