Providence Neurology Clinic Pa | |
220 W Hillside Rd Suite 5 B Laredo TX 78041-6903 | |
(956) 717-4074 | |
(956) 717-4186 |
Full Name | Providence Neurology Clinic Pa |
---|---|
Speciality | Psychiatry & Neurology - Neurology |
Location | 220 W Hillside Rd, Laredo, Texas |
Authorized Official Name and Position | Grace Mukamana (MD/OWNER) |
Authorized Official Contact | 9567174074 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Providence Neurology Clinic Pa 220 W Hillside Rd Suite 5 B Laredo TX 78041-6903 Ph: (956) 717-4074 | Providence Neurology Clinic Pa 220 W Hillside Rd Suite 5 B Laredo TX 78041-6903 Ph: (956) 717-4074 |
NPI Number | 1144555251 |
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Provider Enumeration Date | 10/07/2009 |
Last Update Date | 06/21/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144555251 | NPI | - | NPPES |
210191701 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | N3913 (Texas) | Primary |
2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | N3913 (Texas) | Secondary |
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