Provider Demographics
NPI:1619281953
Name:RIO GRANDE VALLEY ADULT & INTERNAL MEDICINE SPECIALISTS PA
Entity Type:Organization
Organization Name:RIO GRANDE VALLEY ADULT & INTERNAL MEDICINE SPECIALISTS PA
Other - Org Name:MERCEDES CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-1621
Mailing Address - Street 1:208 STARR ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2711
Mailing Address - Country:US
Mailing Address - Phone:956-514-1643
Mailing Address - Fax:
Practice Address - Street 1:1010 JAMES ST
Practice Address - Street 2:SUITE B
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6654
Practice Address - Country:US
Practice Address - Phone:956-968-1621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM4302OtherMEDICAL LICSENCE