Provider Demographics
NPI:1356665863
Name:MOBILE PICC LINES INC
Entity Type:Organization
Organization Name:MOBILE PICC LINES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:956-425-7422
Mailing Address - Street 1:PO BOX 532757
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2844
Mailing Address - Country:US
Mailing Address - Phone:956-425-7422
Mailing Address - Fax:956-440-8882
Practice Address - Street 1:17745 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3536
Practice Address - Country:US
Practice Address - Phone:956-440-9728
Practice Address - Fax:956-440-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105676Medicare UPIN