Provider Demographics
NPI: | 1477960730 |
---|---|
Name: | UNIVERSITY OF TEXAS RIO GRANDE VALLEY |
Entity Type: | Organization |
Organization Name: | UNIVERSITY OF TEXAS RIO GRANDE VALLEY |
Other - Org Name: | UT HEALTH RGV |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PATRIARCA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 956-433-1207 |
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: | 2102 TREASURE HILLS BLVD |
Practice Address - Street 2: | 314406 |
Practice Address - City: | HARLINGEN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78550-8736 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-296-1437 |
Practice Address - Fax: | 956-296-6842 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-07-18 |
Last Update Date: | 2023-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | Group - Multi-Specialty |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
No | 261QA0005X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility | Group - Multi-Specialty |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 343698201 | Medicaid | |
TX | 378931 | Medicare PIN |