Provider Demographics
NPI:1184218570
Name:SOUTH TEXAS VASCULAR INSTITUTE, PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS VASCULAR INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-322-7662
Mailing Address - Street 1:PO BOX 4199
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4199
Mailing Address - Country:US
Mailing Address - Phone:830-632-7912
Mailing Address - Fax:830-632-6568
Practice Address - Street 1:2511 CORNERSTONE BLVD STE 2511
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8463
Practice Address - Country:US
Practice Address - Phone:956-322-7662
Practice Address - Fax:956-338-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty