Basic Information
| Provider Information | |||||||||
| NPI: | 1003924291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERWORLD HEALTHCARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1230 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785511230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564231197 | ||||||||
| FaxNumber: | 9564401837 | ||||||||
| Practice Location | |||||||||
| Address1: | 10767 GATEWAY BLVD W | ||||||||
| Address2: | 605 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155347727 | ||||||||
| FaxNumber: | 9155347898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | MESQUIAS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9155347727 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 016959 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | HH8195 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 023962601 | 05 | TX | MEDICAID |