Provider Demographics
NPI:1649226762
Name:PECAN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PECAN MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:956-661-0040
Mailing Address - Street 1:110 PECAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9557
Mailing Address - Country:US
Mailing Address - Phone:956-661-0040
Mailing Address - Fax:956-661-0042
Practice Address - Street 1:110 PECAN BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9557
Practice Address - Country:US
Practice Address - Phone:956-661-0040
Practice Address - Fax:956-661-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181534201Medicaid
TX00W789Medicare PIN