Provider Demographics
NPI:1194487710
Name:SHALOM PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:SHALOM PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-475-1160
Mailing Address - Street 1:802 E INTERSTATE 2 STE A
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6525
Mailing Address - Country:US
Mailing Address - Phone:956-475-1160
Mailing Address - Fax:956-622-5861
Practice Address - Street 1:802 E INTERSTATE 2 STE A
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6525
Practice Address - Country:US
Practice Address - Phone:956-475-1160
Practice Address - Fax:956-622-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty