Provider Demographics
NPI:1669794657
Name:FAMILY CLINICS OF LAREDO PLLC
Entity type:Organization
Organization Name:FAMILY CLINICS OF LAREDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-285-7785
Mailing Address - Street 1:101 W VILLAGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2211
Mailing Address - Country:US
Mailing Address - Phone:956-727-3047
Mailing Address - Fax:956-717-3630
Practice Address - Street 1:3102 ROSS ST
Practice Address - Street 2:LOOP 20
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4980
Practice Address - Country:US
Practice Address - Phone:956-727-3547
Practice Address - Fax:956-725-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212220201Medicaid
TXTXB100623Medicare PIN