Provider Demographics
NPI:1225180946
Name:OSCAR BENAVIDES MD PA
Entity Type:Organization
Organization Name:OSCAR BENAVIDES MD PA
Other - Org Name:PROF ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICITAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-725-5210
Mailing Address - Street 1:209 W VILLAGE BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2227
Mailing Address - Country:US
Mailing Address - Phone:956-725-5210
Mailing Address - Fax:956-717-1708
Practice Address - Street 1:209 W VILLAGE BLVD STE 11
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2227
Practice Address - Country:US
Practice Address - Phone:956-725-5210
Practice Address - Fax:956-717-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9039207Q00000X
TX0104598332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192463101Medicaid
TX00386NMedicare Oscar/Certification
TX8375J0Medicare PIN
TX5472290001Medicare NSC
TX192463101Medicaid