Provider Demographics
NPI:1952416646
Name:BEACON INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:BEACON INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-712-4343
Mailing Address - Street 1:1710 E SAUNDERS ST STE B490
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5443
Mailing Address - Country:US
Mailing Address - Phone:956-712-4343
Mailing Address - Fax:956-712-9196
Practice Address - Street 1:1710 E SAUNDERS ST STE B490
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-712-4343
Practice Address - Fax:956-712-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0170174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH27765Medicare UPIN
TX00514VMedicare ID - Type Unspecified