| Providence Neurology Clinic Pa | |
|
220 W Hillside Rd Suite 5 B Laredo TX 78041-6903 | |
| (956) 717-4074 | |
| (956) 717-4186 |
| Full Name | Providence Neurology Clinic Pa |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 220 W Hillside Rd, Laredo, Texas |
| Authorized Official Name and Position | Grace Mukamana (MD/OWNER) |
| Authorized Official Contact | 9567174074 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Neurology Clinic Pa 220 W Hillside Rd Suite 5 B Laredo TX 78041-6903 Ph: (956) 717-4074 | Providence Neurology Clinic Pa 220 W Hillside Rd Suite 5 B Laredo TX 78041-6903 Ph: (956) 717-4074 |
| NPI Number | 1144555251 |
|---|---|
| Provider Enumeration Date | 10/07/2009 |
| Last Update Date | 06/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144555251 | NPI | - | NPPES |
| 210191701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | N3913 (Texas) | Primary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | N3913 (Texas) | Secondary |
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