Provider Demographics
NPI:1245404680
Name:VALLEY INTERNAL MEDICINE GERIATRIC & DIABETIC CENTER, P.A.
Entity Type:Organization
Organization Name:VALLEY INTERNAL MEDICINE GERIATRIC & DIABETIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANGALA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-3982
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0627
Mailing Address - Country:US
Mailing Address - Phone:956-631-3982
Mailing Address - Fax:956-631-0254
Practice Address - Street 1:1200 E RIDGE RD STE 7
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1528
Practice Address - Country:US
Practice Address - Phone:956-631-3982
Practice Address - Fax:956-631-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079604701Medicaid
TX00028NMedicare PIN