Provider Demographics
NPI:1558643478
Name:CANOVA INTERNAL MEDICINE CLINIC,PA.
Entity Type:Organization
Organization Name:CANOVA INTERNAL MEDICINE CLINIC,PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:CANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-791-1414
Mailing Address - Street 1:6602 POLARIS DRIVE
Mailing Address - Street 2:STE 5
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-791-1414
Mailing Address - Fax:956-796-9495
Practice Address - Street 1:6602 POLARIS DR.
Practice Address - Street 2:STE 5
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-791-1414
Practice Address - Fax:956-796-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB0183294OtherDPS
TXP0706OtherTX-LICENSE
TXP0706OtherTX-LICENSE