| Records Request | |
|
1200 Central Blvd Ste H1 Brownsville TX 78520-7543 | |
| (956) 572-0033 | |
| Not Available |
| Full Name | Records Request |
|---|---|
| Speciality | Clinical Medical Laboratory |
| Location | 1200 Central Blvd Ste H1, Brownsville, Texas |
| Authorized Official Name and Position | Mark Cortez (MANAGER/OWNER) |
| Authorized Official Contact | 9565720033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Records Request 335 Pinar Del Rio Ave Brownsville TX 78526-1957 Ph: (956) 572-0033 | Records Request 1200 Central Blvd Ste H1 Brownsville TX 78520-7543 Ph: (956) 572-0033 |
| NPI Number | 1205597671 |
|---|---|
| Provider Enumeration Date | 01/06/2022 |
| Last Update Date | 03/17/2022 |
| Medicare PECOS PAC ID | 5991190712 |
|---|---|
| Medicare Enrollment ID | O20220315000156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205597671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Primary |
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