Provider Demographics
NPI:1104913334
Name:PROVIDENCE HOSPITAL LP
Entity type:Organization
Organization Name:PROVIDENCE HOSPITAL LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-693-5022
Mailing Address - Street 1:230 CALLE DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5957
Mailing Address - Country:US
Mailing Address - Phone:956-693-5022
Mailing Address - Fax:956-712-3646
Practice Address - Street 1:230 CALLE DEL NORTE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5957
Practice Address - Country:US
Practice Address - Phone:956-693-5022
Practice Address - Fax:956-712-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450879Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER