Provider Demographics
NPI:1912182577
Name:DR LUIS M RIOS M D P A
Entity Type:Organization
Organization Name:DR LUIS M RIOS M D P A
Other - Org Name:LUIS M. RIOS, JR.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-682-3147
Mailing Address - Street 1:2101 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8301
Mailing Address - Country:US
Mailing Address - Phone:956-682-3147
Mailing Address - Fax:956-682-3511
Practice Address - Street 1:2101 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8301
Practice Address - Country:US
Practice Address - Phone:956-682-3147
Practice Address - Fax:956-682-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0221208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152179101Medicaid
TX031479101Medicaid
TX00701ROtherMEDICARE PTAN
TX0059GSOtherBLUE CROSS/BLUE SHIELD GR
TX8B6021OtherBLUE CROSS/BLUE SHIELD
TXG76514Medicare UPIN
TX152179101Medicaid