Provider Demographics
NPI:1013930080
Name:VALLEY MEDICAL ARTS CLINIC PA
Entity Type:Organization
Organization Name:VALLEY MEDICAL ARTS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD CEO
Authorized Official - Phone:956-631-5411
Mailing Address - Street 1:5201 N 10TH
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-631-5411
Mailing Address - Fax:956-631-7129
Practice Address - Street 1:5201 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2708
Practice Address - Country:US
Practice Address - Phone:956-631-5411
Practice Address - Fax:956-631-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094043903Medicaid
TX00661RMedicare PIN