| Bethsaida Nephrology And Internal Medicine | |
|
1405 Jacaman Rd Ste 102 Laredo TX 78041-6225 | |
| (956) 568-9657 | |
| (956) 568-9659 |
| Full Name | Bethsaida Nephrology And Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1405 Jacaman Rd Ste 102, Laredo, Texas |
| Authorized Official Name and Position | Olayinka Omowunmi Holt (DIRECTOR) |
| Authorized Official Contact | 3473503187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethsaida Nephrology And Internal Medicine 1405 Jacaman Rd Ste 102 Laredo TX 78041-6225 Ph: (956) 568-9657 | Bethsaida Nephrology And Internal Medicine 1405 Jacaman Rd Ste 102 Laredo TX 78041-6225 Ph: (956) 568-9657 |
| NPI Number | 1619314366 |
|---|---|
| Provider Enumeration Date | 06/03/2013 |
| Last Update Date | 05/01/2018 |
| Medicare PECOS PAC ID | 3173758745 |
|---|---|
| Medicare Enrollment ID | O20131107000513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619314366 | NPI | - | NPPES |
| 333074801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | P1765 (Texas) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | P1765 (Texas) | Primary |
| Provider Name | Olayinka O Holt |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1871876011 PECOS PAC ID: 7618128349 Enrollment ID: I20121106000488 |
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