Provider Demographics
NPI:1518441567
Name:AMPUTATION PREVENTION CENTER OF MISSION PA
Entity Type:Organization
Organization Name:AMPUTATION PREVENTION CENTER OF MISSION PA
Other - Org Name:MISSION VASCULAR CENTER OF EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-878-9610
Mailing Address - Street 1:5601 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2732
Mailing Address - Country:US
Mailing Address - Phone:956-878-9610
Mailing Address - Fax:
Practice Address - Street 1:1317 ST CLAIRE BLVD STE A5
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6636
Practice Address - Country:US
Practice Address - Phone:956-212-3853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-16
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty