| Elizondo Medical Group | |
|
230 S Gulf St Alice TX 78332-4310 | |
| (361) 664-0303 | |
| (866) 845-0933 |
| Full Name | Elizondo Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 230 S Gulf St, Alice, Texas |
| Authorized Official Name and Position | Carlos Rafael Elizondo (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3616640303 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizondo Medical Group Po Box 850 Alice TX 78333-0850 Ph: (361) 664-0303 | Elizondo Medical Group 230 S Gulf St Alice TX 78332-4310 Ph: (361) 664-0303 |
| NPI Number | 1104278860 |
|---|---|
| Provider Enumeration Date | 07/06/2016 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 0749576874 |
|---|---|
| Medicare Enrollment ID | O20160915001121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104278860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | Q6183 (Texas) | Primary |
| Provider Name | Heather A Kostoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568615318 PECOS PAC ID: 0345410536 Enrollment ID: I20110825000437 |
| Provider Name | Kelli M Hubert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124383245 PECOS PAC ID: 0143479683 Enrollment ID: I20120927000427 |
| Provider Name | Nancy Rose Mcdowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710234398 PECOS PAC ID: 0446569354 Enrollment ID: I20151015001580 |
| Provider Name | Carlos Elizondo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417391764 PECOS PAC ID: 2860618634 Enrollment ID: I20160915001349 |
| Provider Name | Jeremiah Jeff Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750845343 PECOS PAC ID: 6709125909 Enrollment ID: I20190306001460 |
| Provider Name | Brianna Lynn Plank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730884644 PECOS PAC ID: 9335504869 Enrollment ID: I20230504002909 |
| Provider Name | Miguel Andres Elizondo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326667965 PECOS PAC ID: 1052733540 Enrollment ID: I20230607000028 |
| Provider Name | Ricardo Elias Mendiondo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124763875 PECOS PAC ID: 1456794874 Enrollment ID: I20240213000754 |
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