Provider Demographics
NPI:1952471344
Name:MANUEL R. CARRASCO,MD,PA
Entity Type:Organization
Organization Name:MANUEL R. CARRASCO,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-714-4500
Mailing Address - Street 1:1501 W 11TH PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4119
Mailing Address - Country:US
Mailing Address - Phone:432-714-4500
Mailing Address - Fax:
Practice Address - Street 1:1501 W 11TH PL
Practice Address - Street 2:SUITE 302
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4119
Practice Address - Country:US
Practice Address - Phone:432-714-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF41711Medicare UPIN
TX00853VMedicare PIN