Provider Demographics
NPI:1366972366
Name:AMPAC MEDICAL MANAGEMENT SERVICES LLC
Entity type:Organization
Organization Name:AMPAC MEDICAL MANAGEMENT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:956-329-9441
Mailing Address - Street 1:1900 W UNIVERSITY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2865
Mailing Address - Country:US
Mailing Address - Phone:956-627-3552
Mailing Address - Fax:956-627-3666
Practice Address - Street 1:1900 W UNIVERSITY DR STE 7
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2865
Practice Address - Country:US
Practice Address - Phone:956-627-3552
Practice Address - Fax:956-627-3666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMPAC MEDICAL MANAGEMENT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID