Provider Demographics
NPI:1891965745
Name:MARIO A. ECHAVARRIA MD PA
Entity Type:Organization
Organization Name:MARIO A. ECHAVARRIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ECHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-971-9999
Mailing Address - Street 1:3001 N 23RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6178
Mailing Address - Country:US
Mailing Address - Phone:956-971-9999
Mailing Address - Fax:
Practice Address - Street 1:3001 N 23RD ST STE 3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6178
Practice Address - Country:US
Practice Address - Phone:956-971-9999
Practice Address - Fax:956-971-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3631208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157001201Medicaid
00814UMedicare PIN