Provider Demographics
NPI:1437194875
Name:SOUTH TEXAS NEUROLOGICAL CENTER, P.A.
Entity Type:Organization
Organization Name:SOUTH TEXAS NEUROLOGICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-687-7885
Mailing Address - Street 1:1910 S 1ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1255
Mailing Address - Country:US
Mailing Address - Phone:956-687-7885
Mailing Address - Fax:956-687-3101
Practice Address - Street 1:1910 S 1ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1255
Practice Address - Country:US
Practice Address - Phone:956-687-7885
Practice Address - Fax:956-687-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH16272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016GNOtherBLUE CROSS/SHIELD OF TEXA
TX032736301Medicaid
TX032736301Medicaid
TXOODA93Medicare PIN