Provider Demographics
NPI:1225263650
Name:MALEXA MEDICAL SERVICES
Entity Type:Organization
Organization Name:MALEXA MEDICAL SERVICES
Other - Org Name:ROCKPORT REJUVENATIVE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:VONHEUVEL
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:361-790-7790
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78381-1389
Mailing Address - Country:US
Mailing Address - Phone:361-790-7790
Mailing Address - Fax:361-790-7785
Practice Address - Street 1:1521 W MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-6218
Practice Address - Country:US
Practice Address - Phone:361-790-7790
Practice Address - Fax:361-790-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2085508-01Medicaid
TX2085508-01Medicaid