Provider Demographics
NPI:1457302085
Name:LA FERIA MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:LA FERIA MEDICAL CLINIC, P.A.
Other - Org Name:LA FERIA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-428-3701
Mailing Address - Street 1:129 W COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-5108
Mailing Address - Country:US
Mailing Address - Phone:956-797-9200
Mailing Address - Fax:956-797-1018
Practice Address - Street 1:129 W COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-5108
Practice Address - Country:US
Practice Address - Phone:956-797-9200
Practice Address - Fax:956-797-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158340302OtherEPSDT
TX158340301Medicaid
TX158340301Medicaid