| Prof Association | |
|
209 W Village Blvd Ste 11 Laredo TX 78041-2227 | |
| (956) 725-5210 | |
| (956) 717-1708 |
| Full Name | Prof Association |
|---|---|
| Speciality | Family Medicine |
| Location | 209 W Village Blvd Ste 11, Laredo, Texas |
| Authorized Official Name and Position | Felicitas Benavides (MANAGER) |
| Authorized Official Contact | 9567255210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prof Association 209 W Village Blvd Ste 11 Laredo TX 78041-2227 Ph: (956) 725-5210 | Prof Association 209 W Village Blvd Ste 11 Laredo TX 78041-2227 Ph: (956) 725-5210 |
| NPI Number | 1225180946 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 10/17/2019 |
| Medicare PECOS PAC ID | 8224024724 |
|---|---|
| Medicare Enrollment ID | O20040421000928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225180946 | NPI | - | NPPES |
| 192463101 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H9039 (Texas) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 0104598 (Texas) | Secondary |
| Provider Name | Oscar Benavides |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356493977 PECOS PAC ID: 3274529789 Enrollment ID: I20040421000963 |
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