Provider Demographics
NPI:1851411052
Name:INEMESIT EPHRAM UDOR MD. P.A.
Entity Type:Organization
Organization Name:INEMESIT EPHRAM UDOR MD. P.A.
Other - Org Name:THE VALLEY NEIGHBORHOOD PEDIATRIC NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INEMESIT
Authorized Official - Middle Name:E
Authorized Official - Last Name:UDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:956-631-7312
Mailing Address - Street 1:2517 W TRENTON RD.
Mailing Address - Street 2:BIDG A STE 4
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5070
Mailing Address - Country:US
Mailing Address - Phone:956-631-7312
Mailing Address - Fax:956-631-7307
Practice Address - Street 1:2517 W. TRENTON RD.
Practice Address - Street 2:BLDG A STE 4
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5070
Practice Address - Country:US
Practice Address - Phone:956-631-7312
Practice Address - Fax:956-631-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120285OtherSUPERIOR HEALTH PLAN
TX0092HGOtherBC&BS OF TEXAS
TX145956202Medicaid
TX116400604Medicaid
TX145956201Medicaid
145956202OtherEPSOT
K6377OtherTEXAS LIC
TX116400604Medicaid
TXG76299Medicare UPIN
TX145956202Medicaid