Provider Demographics
NPI:1700067808
Name:FAMILY SPECIALISTS MEDICAL CENTER PA
Entity Type:Organization
Organization Name:FAMILY SPECIALISTS MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-585-1564
Mailing Address - Street 1:2401 SE AUGUSTA SQ
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1105
Mailing Address - Country:US
Mailing Address - Phone:956-585-1564
Mailing Address - Fax:956-585-2830
Practice Address - Street 1:1605 E EXPRESSWAY 83
Practice Address - Street 2:SUITE D
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6616
Practice Address - Country:US
Practice Address - Phone:956-585-1564
Practice Address - Fax:956-585-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031DMOtherBCBS
TX092297301Medicaid
TX00888KMedicare PIN