Provider Demographics
NPI:1922750470
Name:SAN BENITO MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SAN BENITO MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHACHERL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-247-7000
Mailing Address - Street 1:351 N SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4696
Mailing Address - Country:US
Mailing Address - Phone:956-247-7000
Mailing Address - Fax:956-626-1161
Practice Address - Street 1:100C E ALTON GLOOR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3329
Practice Address - Country:US
Practice Address - Phone:956-247-7000
Practice Address - Fax:956-626-1161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN BENITO MEDICA ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-25
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121454601Medicaid