Provider Demographics
NPI:1881717494
Name:PRICE VILLAGE FAMILY CLINIC
Entity type:Organization
Organization Name:PRICE VILLAGE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CAQUIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-831-9353
Mailing Address - Street 1:625 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4215
Mailing Address - Country:US
Mailing Address - Phone:956-831-9353
Mailing Address - Fax:956-831-7749
Practice Address - Street 1:625 E PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4215
Practice Address - Country:US
Practice Address - Phone:956-831-9353
Practice Address - Fax:956-831-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DG85Medicare ID - Type UnspecifiedMEDICARE NUMBER