Provider Demographics
NPI:1013259811
Name:MEDICINE CLINIC
Entity Type:Organization
Organization Name:MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:UGARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-872-0477
Mailing Address - Street 1:9963A ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-2963
Mailing Address - Country:US
Mailing Address - Phone:915-872-0477
Mailing Address - Fax:915-872-0484
Practice Address - Street 1:9963A ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-2963
Practice Address - Country:US
Practice Address - Phone:915-872-0477
Practice Address - Fax:915-872-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6784207R00000X
TX534465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127013402Medicaid
TXG08733Medicare UPIN
TX00T21FMedicare PIN