Provider Demographics
NPI:1942675962
Name:RGV PREMIER HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:RGV PREMIER HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-605-4413
Mailing Address - Street 1:4413 W BUSINESS 83
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-8607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4413 W BUSINESS 83
Practice Address - Street 2:SUITE 8
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-8607
Practice Address - Country:US
Practice Address - Phone:956-605-4413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty