Provider Demographics
NPI:1720054406
Name:MCALLEN BONE & JOINT CLINIC PA
Entity Type:Organization
Organization Name:MCALLEN BONE & JOINT CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-618-4414
Mailing Address - Street 1:1421 N 2ND ST STE A
Mailing Address - Street 2:COL ROWE BLVD
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2303
Mailing Address - Country:US
Mailing Address - Phone:956-618-4414
Mailing Address - Fax:956-630-4136
Practice Address - Street 1:1421 N 2ND ST STE A
Practice Address - Street 2:COL ROWE BLVD
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2303
Practice Address - Country:US
Practice Address - Phone:956-618-4414
Practice Address - Fax:956-630-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023466801Medicaid
TX079933001Medicaid
TX0011BYOtherBLUE CROSS BLUE SHIELD
TX023466802Medicaid
TX0011BYOtherBLUE CROSS BLUE SHIELD
TX079933001Medicaid
TX0011BYMedicare PIN