Provider Demographics
NPI:1306396031
Name:IVANA ENTERPRISES, INC
Entity Type:Organization
Organization Name:IVANA ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-212-0902
Mailing Address - Street 1:1018 BEECH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4547
Mailing Address - Country:US
Mailing Address - Phone:956-800-5171
Mailing Address - Fax:956-800-5178
Practice Address - Street 1:1018 BEECH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-800-5171
Practice Address - Fax:956-800-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5188207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX538967OtherMEDICARE
00P1Z0OtherBCBS
TX364593901Medicaid
TXDX2502OtherRR MEDICARE