Provider Demographics
NPI:1376657023
Name:PADRE ISLAND HEALTH SPECIALISTS PA
Entity Type:Organization
Organization Name:PADRE ISLAND HEALTH SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:POSADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-772-1911
Mailing Address - Street 1:3401 PADRE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PADRE ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78597-7124
Mailing Address - Country:US
Mailing Address - Phone:956-772-1911
Mailing Address - Fax:956-772-9010
Practice Address - Street 1:3401 PADRE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597-7124
Practice Address - Country:US
Practice Address - Phone:956-772-1911
Practice Address - Fax:956-772-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169024001Medicaid
00475WMedicare PIN