Provider Demographics
NPI:1700893849
Name:MISSION DOCTORS GROUP
Entity Type:Organization
Organization Name:MISSION DOCTORS GROUP
Other - Org Name:MISSION HEART AND VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SURROCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:956-323-9106
Mailing Address - Street 1:910 S BRYAN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6615
Mailing Address - Country:US
Mailing Address - Phone:956-598-7000
Mailing Address - Fax:956-598-7001
Practice Address - Street 1:910 S BRYAN RD STE 103
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6615
Practice Address - Country:US
Practice Address - Phone:956-598-7000
Practice Address - Fax:956-598-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080646502Medicaid
TX0033DEOtherBCBS PIN
TX080646502Medicaid