Provider Demographics
NPI:1154412260
Name:LIDIA LEMARROY
Entity type:Organization
Organization Name:LIDIA LEMARROY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMARROY
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:956-969-1323
Mailing Address - Street 1:309 S TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6113
Mailing Address - Country:US
Mailing Address - Phone:956-969-1323
Mailing Address - Fax:956-968-8803
Practice Address - Street 1:2605 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2311
Practice Address - Country:US
Practice Address - Phone:956-542-0333
Practice Address - Fax:956-986-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016930201Medicaid
TX121001504Medicaid
TX532312OtherBLUE CROSS BLUE SHIELD
TX121001504Medicaid