Provider Demographics
NPI:1831131143
Name:RENAISSANCE EMERGENCY PHYSICIANS,PA
Entity Type:Organization
Organization Name:RENAISSANCE EMERGENCY PHYSICIANS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:CORTINAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-687-9997
Mailing Address - Street 1:4745 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8309
Mailing Address - Country:US
Mailing Address - Phone:386-274-7860
Mailing Address - Fax:833-547-6525
Practice Address - Street 1:5501 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9152
Practice Address - Country:US
Practice Address - Phone:956-664-1437
Practice Address - Fax:956-661-7361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170447001Medicaid