Provider Demographics
NPI:1275992760
Name:PALLI-MED HOSPICE, LLC
Entity Type:Organization
Organization Name:PALLI-MED HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EYAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:956-627-2744
Mailing Address - Street 1:1310 E MAIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1661
Mailing Address - Country:US
Mailing Address - Phone:956-627-2744
Mailing Address - Fax:956-627-5625
Practice Address - Street 1:817 N WARE RD SUITE 4
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-627-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016955251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011027317Medicaid
TX741530Medicare Oscar/Certification