Provider Demographics
NPI:1780634766
Name:DRISCOLL VALLEY PHYSICIANS GROUP
Entity Type:Organization
Organization Name:DRISCOLL VALLEY PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERMUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-694-6257
Mailing Address - Street 1:1120 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5411
Mailing Address - Country:US
Mailing Address - Phone:956-688-1280
Mailing Address - Fax:956-688-1291
Practice Address - Street 1:1120 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5411
Practice Address - Country:US
Practice Address - Phone:956-688-1280
Practice Address - Fax:956-688-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170789501Medicaid
TX170789502OtherCSHCN
TX0036LWOtherBC/BS
TX00830XMedicare ID - Type Unspecified