Provider Demographics
NPI:1396790994
Name:SOUTHSIDE NIGHT CLINIC
Entity type:Organization
Organization Name:SOUTHSIDE NIGHT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-5995
Mailing Address - Street 1:717 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-3006
Mailing Address - Country:US
Mailing Address - Phone:956-631-5995
Mailing Address - Fax:956-631-1372
Practice Address - Street 1:717 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-3006
Practice Address - Country:US
Practice Address - Phone:956-631-5995
Practice Address - Fax:956-631-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092136301Medicaid