Provider Demographics
NPI:1881834539
Name:IRIS WELL CHILD PHYSICALS
Entity Type:Organization
Organization Name:IRIS WELL CHILD PHYSICALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PNP
Authorized Official - Phone:956-262-9805
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-1274
Mailing Address - Country:US
Mailing Address - Phone:956-262-9805
Mailing Address - Fax:956-262-9233
Practice Address - Street 1:200 W. EDINBURG HWY 107
Practice Address - Street 2:SUITE B
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1274
Practice Address - Country:US
Practice Address - Phone:956-262-9805
Practice Address - Fax:956-262-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533197364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121084102OtherMEDICAID-EPSDT
TX121392OtherSUPERIOR HEALTHPLAN NETWORK
TX8N8564OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX121084101Medicaid