Provider Demographics
NPI:1437370103
Name:MEDWIN FAMILY MEDICINE & REHABILITATION PC
Entity Type:Organization
Organization Name:MEDWIN FAMILY MEDICINE & REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANJULA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-546-7530
Mailing Address - Street 1:PO BOX 5386
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-5386
Mailing Address - Country:US
Mailing Address - Phone:956-546-7530
Mailing Address - Fax:956-546-7531
Practice Address - Street 1:315 JOSE MARTI BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-2868
Practice Address - Country:US
Practice Address - Phone:956-546-7530
Practice Address - Fax:956-546-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176203101Medicaid
TX176203101Medicaid