Provider Demographics
NPI:1477740926
Name:MISSION ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:MISSION ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-581-6228
Mailing Address - Street 1:1313 ST CLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6654
Mailing Address - Country:US
Mailing Address - Phone:956-581-6228
Mailing Address - Fax:956-581-8378
Practice Address - Street 1:1313 ST CLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6654
Practice Address - Country:US
Practice Address - Phone:956-581-6228
Practice Address - Fax:956-581-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084916801Medicaid
TX123170603Medicaid
TXC14229Medicare UPIN
TX084916801Medicaid