Provider Demographics
NPI:1245214998
Name:SUPERIOR FAMILY CLINIC, P.A.
Entity Type:Organization
Organization Name:SUPERIOR FAMILY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FEDERICO
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-721-4451
Mailing Address - Street 1:4619 SAN DARIO AVE
Mailing Address - Street 2:#310
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5773
Mailing Address - Country:US
Mailing Address - Phone:956-753-3901
Mailing Address - Fax:956-753-3434
Practice Address - Street 1:6930 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2312
Practice Address - Country:US
Practice Address - Phone:956-753-3901
Practice Address - Fax:956-753-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2195Medicare PIN
I21332Medicare UPIN