Provider Demographics
NPI:1194293969
Name:ISLAND MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:ISLAND MEDICAL CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:956-491-9364
Mailing Address - Street 1:1700 W DOVE AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4464
Mailing Address - Country:US
Mailing Address - Phone:956-704-9192
Mailing Address - Fax:956-615-8904
Practice Address - Street 1:1700 W DOVE AVE STE 20
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4464
Practice Address - Country:US
Practice Address - Phone:956-704-9192
Practice Address - Fax:956-615-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health