Provider Demographics
NPI:1104529320
Name:MEDICO HEALTHCARE, PLLC
Entity type:Organization
Organization Name:MEDICO HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN CARLOS ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-260-8013
Mailing Address - Street 1:13650 EASTLAKE BLVD STE A-104
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7473
Mailing Address - Country:US
Mailing Address - Phone:915-260-8013
Mailing Address - Fax:915-213-0628
Practice Address - Street 1:13650 EASTLAKE BLVD STE A-104
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7473
Practice Address - Country:US
Practice Address - Phone:915-314-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty