Full Name | |
---|---|
Speciality | Family Medicine |
Location | 640 E Bravo Blvd, Roma, Texas |
Authorized Official Name and Position | Raymond P Mussett (PRESIDENT/OWNER) |
Authorized Official Contact | 9568492176 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1120 Roma TX 78584 Ph: (956) 849-2176 | 640 E Bravo Blvd Roma TX 78584 Ph: (956) 849-2176 |
NPI Number | 1093822140 |
---|---|
Provider Enumeration Date | 08/24/2006 |
Last Update Date | 10/02/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093822140 | NPI | - | NPPES |
827083763 | Other | TX | PALMETTO MEDICARE |
135201506 | Medicaid | TX | |
00734HF | Other | TX | BCBS |
063426301 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Texas) | Primary |
Nuestra Clinica Del Valle Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2891 E Grant St, Roma, TX 78584 Phone: 956-849-2100 Fax: 956-787-8915 | |