Provider Demographics
NPI:1407829633
Name:MID VALLEY FAMILY PRACTICE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MID VALLEY FAMILY PRACTICE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-969-2536
Mailing Address - Street 1:1710 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6646
Mailing Address - Country:US
Mailing Address - Phone:956-969-2536
Mailing Address - Fax:956-968-5542
Practice Address - Street 1:1710 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6646
Practice Address - Country:US
Practice Address - Phone:956-969-2536
Practice Address - Fax:956-968-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00975ZMedicare PIN