Provider Demographics
NPI:1437330263
Name:LAREDO CARDIOLOGY CENTER
Entity Type:Organization
Organization Name:LAREDO CARDIOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-717-2328
Mailing Address - Street 1:10710 MCPHERSON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6363
Mailing Address - Country:US
Mailing Address - Phone:956-717-2328
Mailing Address - Fax:956-717-2395
Practice Address - Street 1:10710 MCPHERSON RD STE 105
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6363
Practice Address - Country:US
Practice Address - Phone:956-717-2328
Practice Address - Fax:956-717-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3390207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4950OtherBCBS OF TEXAS
TX=========OtherTAX IDENTIFICATION NUMBER
TX00106FMedicare PIN
TXH51808Medicare UPIN