Provider Demographics
NPI:1386895225
Name:RGV PREVENTATIVE CARE, INC
Entity type:Organization
Organization Name:RGV PREVENTATIVE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAMBULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-971-0077
Mailing Address - Street 1:500 S BICENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5275
Mailing Address - Country:US
Mailing Address - Phone:956-971-0077
Mailing Address - Fax:956-971-0076
Practice Address - Street 1:500 S BICENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5275
Practice Address - Country:US
Practice Address - Phone:956-971-0077
Practice Address - Fax:956-971-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR31044261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y513Medicare PIN