Basic Information
| Provider Information | |||||||||
| NPI: | 1205368602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAHEY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | NICHOLAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 TREASURE HILLS BLVD # 3.14406 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562961437 | ||||||||
| FaxNumber: | 9562966842 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E DOVE AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785043974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563623520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | S4465 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | H08MV75001 | 01 | TX | BCBS | OTHER |