Provider Demographics
NPI:1164586194
Name:MERCY MINISTRIES OF LAREDO
Entity Type:Organization
Organization Name:MERCY MINISTRIES OF LAREDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MARIA
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-721-7401
Mailing Address - Street 1:2500 ZACATECAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6814
Mailing Address - Country:US
Mailing Address - Phone:956-718-6810
Mailing Address - Fax:956-721-7405
Practice Address - Street 1:2500 ZACATECAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-6814
Practice Address - Country:US
Practice Address - Phone:956-718-6810
Practice Address - Fax:956-721-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246295261QP2300X
TX500252363LF0000X
TX532626363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1782526Medicaid
TX1782526Medicaid