Provider Demographics
NPI:1467627349
Name:DONNA MEDICAL CLINIC
Entity Type:Organization
Organization Name:DONNA MEDICAL CLINIC
Other - Org Name:ELSA MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-262-1304
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-0337
Mailing Address - Country:US
Mailing Address - Phone:956-464-2402
Mailing Address - Fax:956-464-5806
Practice Address - Street 1:101 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78537
Practice Address - Country:US
Practice Address - Phone:956-262-1304
Practice Address - Fax:956-262-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00268UMedicare PIN