Provider Demographics
NPI:1013242874
Name:STANISLAUS NWAFOR UZOIGWE MD PA
Entity Type:Organization
Organization Name:STANISLAUS NWAFOR UZOIGWE MD PA
Other - Org Name:PEDIATRIC PRACTICE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-488-1200
Mailing Address - Street 1:1301 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-3570
Mailing Address - Country:US
Mailing Address - Phone:956-765-0770
Mailing Address - Fax:956-765-0660
Practice Address - Street 1:1301 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-3570
Practice Address - Country:US
Practice Address - Phone:956-765-0770
Practice Address - Fax:956-765-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217512701Medicaid
TX673915Medicare PIN