Provider Demographics
NPI:1437250081
Name:LOUIE L. MENDIOLA MD, PA
Entity Type:Organization
Organization Name:LOUIE L. MENDIOLA MD, PA
Other - Org Name:LUIS L MENDIOLA MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-826-3576
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:309 E 9TH
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096-0190
Mailing Address - Country:US
Mailing Address - Phone:806-826-3576
Mailing Address - Fax:806-826-5201
Practice Address - Street 1:309 E 9TH
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:TX
Practice Address - Zip Code:79096
Practice Address - Country:US
Practice Address - Phone:806-826-3576
Practice Address - Fax:806-826-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076QFOtherBC/BS
TXDP8309OtherRAILROAD MEDICARE
TX0A5697Medicare PIN