Basic Information
| Provider Information | |||||||||
| NPI: | 1184218570 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH TEXAS VASCULAR INSTITUTE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4199 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785024199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306327912 | ||||||||
| FaxNumber: | 8306326568 | ||||||||
| Practice Location | |||||||||
| Address1: | 2511 CORNERSTONE BLVD STE 2511 | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785398463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563227662 | ||||||||
| FaxNumber: | 9563385709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2021 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROOKSHIRE | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9563227662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.