Provider Demographics
NPI:1326114059
Name:UPPER VALLEY HEMORRHOID CLINIC PA
Entity Type:Organization
Organization Name:UPPER VALLEY HEMORRHOID CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLON & RECTAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PASTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-4441
Mailing Address - Street 1:880 RIDGEWOOD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-541-4441
Mailing Address - Fax:956-541-5474
Practice Address - Street 1:880 RIDGEWOOD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-541-4441
Practice Address - Fax:956-541-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1811208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M7840OtherBCBS
TX035865702Medicaid
B20891Medicare UPIN
TX8M7840OtherBCBS