Provider Demographics
NPI:1558766758
Name:COLUMBIA RIO GRANDE HEALTHCARE,L.P.
Entity Type:Organization
Organization Name:COLUMBIA RIO GRANDE HEALTHCARE,L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-632-6101
Mailing Address - Street 1:222 E RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1251
Mailing Address - Country:US
Mailing Address - Phone:956-632-6032
Mailing Address - Fax:956-971-9539
Practice Address - Street 1:427 E DURANTA AVE STE 108
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-3409
Practice Address - Country:US
Practice Address - Phone:956-787-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518243363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty