Provider Demographics
NPI:1659974657
Name:MERCED FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:MERCED FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,FNP-BC
Authorized Official - Phone:956-225-2625
Mailing Address - Street 1:PO BOX 3371
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0057
Mailing Address - Country:US
Mailing Address - Phone:956-225-2625
Mailing Address - Fax:956-598-6069
Practice Address - Street 1:202 PALMVIEW DR STE 1
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-9394
Practice Address - Country:US
Practice Address - Phone:956-225-2625
Practice Address - Fax:956-598-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306843347OtherJRL NPI
TX1391708-22Medicaid
TX1639137193OtherDOC NPI