| San Martin De Porres Clinic | |
|
1337 E Palma Vista Dr Ste A Palmview TX 78572-2055 | |
| (956) 519-9500 | |
| (956) 519-4549 |
| Full Name | San Martin De Porres Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 1337 E Palma Vista Dr Ste A, Palmview, Texas |
| Authorized Official Name and Position | Jhonny Martin Bazan (OWNER MD/ PROVIDER/ PRESIDENT) |
| Authorized Official Contact | 9565199500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Martin De Porres Clinic 1337 E Palma Vista Dr Ste A Palmview TX 78572-2055 Ph: (956) 519-9500 | San Martin De Porres Clinic 1337 E Palma Vista Dr Ste A Palmview TX 78572-2055 Ph: (956) 519-9500 |
| NPI Number | 1710048756 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 10/19/2024 |
| Medicare PECOS PAC ID | 2769421767 |
|---|---|
| Medicare Enrollment ID | O20050428000997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710048756 | NPI | - | NPPES |
| 041729705 | Medicaid | TX | |
| 041729703 | Medicaid | TX | |
| 173560701 | Medicaid | TX | |
| 220041063 | Other | TX | CASE MANAGEMENT |
| 0066NL | Other | TX | BLUE CROSS BLUE SHIELD |
| 1912169459 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | K1355 (Texas) | Secondary |
| 208D00000X | General Practice | K1355 (Texas) | Secondary |
| Provider Name | Jhonny M Bazan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760542807 PECOS PAC ID: 2466417910 Enrollment ID: I20041123000945 |
Hobert L Smith, Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 703 N Bentsen Palm Dr, Ste. H, Palmview, TX 78574 Phone: 956-483-9099 Fax: 956-313-0961 | |
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