Provider Demographics
NPI:1700206133
Name:QUALITY CARE MEDICAL CENTER OF KINGSVILLE PA
Entity Type:Organization
Organization Name:QUALITY CARE MEDICAL CENTER OF KINGSVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:361-592-8588
Mailing Address - Street 1:510 E CAESAR AVE.
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363
Mailing Address - Country:US
Mailing Address - Phone:361-502-8588
Mailing Address - Fax:361-592-2357
Practice Address - Street 1:510 E CAESAR AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363
Practice Address - Country:US
Practice Address - Phone:361-502-8588
Practice Address - Fax:361-592-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8082207R00000X
TXPA03924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty