Provider Demographics
NPI:1669747440
Name:EL REY PRIMARY HEALTH CARE, LLC.
Entity type:Organization
Organization Name:EL REY PRIMARY HEALTH CARE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-968-7100
Mailing Address - Street 1:3622 MORELAND DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-9131
Mailing Address - Country:US
Mailing Address - Phone:956-968-7100
Mailing Address - Fax:956-968-7116
Practice Address - Street 1:3622 MORELAND DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-9131
Practice Address - Country:US
Practice Address - Phone:956-968-7100
Practice Address - Fax:956-968-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0085913747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012813Medicaid