Provider Demographics
NPI:1205851938
Name:WESLACO MID VALLEY NIGHT CLINIC PA
Entity Type:Organization
Organization Name:WESLACO MID VALLEY NIGHT CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PICHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:956-533-0660
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0713
Mailing Address - Country:US
Mailing Address - Phone:956-969-2609
Mailing Address - Fax:
Practice Address - Street 1:1010 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6600
Practice Address - Country:US
Practice Address - Phone:956-969-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB85182Medicare UPIN