Provider Demographics
NPI:1851691307
Name:STANISLAUS NWAFOR UZOIGWE MD PA
Entity Type:Organization
Organization Name:STANISLAUS NWAFOR UZOIGWE MD PA
Other - Org Name:PEDIATRIC PRACTICE ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-488-1200
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3803
Mailing Address - Country:US
Mailing Address - Phone:956-488-1200
Mailing Address - Fax:956-488-9500
Practice Address - Street 1:1505 N GRANT ST STE 1
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5429
Practice Address - Country:US
Practice Address - Phone:956-847-4007
Practice Address - Fax:956-488-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163872801Medicaid