Provider Demographics
NPI:1437638525
Name:THE UNIVERSITY OF TEXAS RIO GRANDE VALLEY
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TEXAS RIO GRANDE VALLEY
Other - Org Name:UT HEALTH RIO GRANDE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN, SCHOOL OF MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-296-1445
Mailing Address - Street 1:2102 TREASURE HILLS BLVD # 314406
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:2106 TREASURE HILLS BLVD # 1.326
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8736
Practice Address - Country:US
Practice Address - Phone:956-296-1519
Practice Address - Fax:956-296-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2023-03-16
Deactivation Date:2021-11-01
Deactivation Code:
Reactivation Date:2022-03-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Q45TOtherBCBS EMPLOYEE PLAN
TX343698201Medicaid