Provider Demographics
NPI:1063601854
Name:POPEK MEDICAL CLINIC
Entity type:Organization
Organization Name:POPEK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POPEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-686-3752
Mailing Address - Street 1:PO BOX 4706
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4706
Mailing Address - Country:US
Mailing Address - Phone:956-686-3752
Mailing Address - Fax:956-686-5414
Practice Address - Street 1:520 S 15TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5202
Practice Address - Country:US
Practice Address - Phone:956-686-3752
Practice Address - Fax:956-686-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9041207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081934401Medicaid
00CT09Medicare PIN
C20596Medicare UPIN