Provider Demographics
NPI:1841277118
Name:1810 BLDG., LTD.
Entity type:Organization
Organization Name:1810 BLDG., LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-9392
Mailing Address - Street 1:1810 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6648
Mailing Address - Country:US
Mailing Address - Phone:956-968-9392
Mailing Address - Fax:956-968-5722
Practice Address - Street 1:1810 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6648
Practice Address - Country:US
Practice Address - Phone:956-968-9392
Practice Address - Fax:956-968-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640450000261QR0400X
TX553070000261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157355201Medicaid
TX000028EXOtherBCBS
TX157355201Medicaid
TX676539Medicare Oscar/Certification