Provider Demographics
NPI:1578672457
Name:SAN MIGUEL FAMILY MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:SAN MIGUEL FAMILY MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAN MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-682-8496
Mailing Address - Street 1:713 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6616
Mailing Address - Country:US
Mailing Address - Phone:956-682-8496
Mailing Address - Fax:956-682-0590
Practice Address - Street 1:713 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6616
Practice Address - Country:US
Practice Address - Phone:956-682-8496
Practice Address - Fax:956-682-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156530102Medicaid
TX00685UMedicare PIN