| Renaissance Icu Group | |
|
5501 S Mccoll Rd Edinburg TX 78539-5503 | |
| (956) 362-8677 | |
| (956) 362-3849 |
| Full Name | Renaissance Icu Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 5501 S Mccoll Rd, Edinburg, Texas |
| Authorized Official Name and Position | Ada X Gonzalez (ADMINISTRATOR) |
| Authorized Official Contact | 9563622171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Icu Group Po Box 6148 Mcallen TX 78502-6148 Ph: (956) 362-8677 | Renaissance Icu Group 5501 S Mccoll Rd Edinburg TX 78539-5503 Ph: (956) 362-8677 |
| NPI Number | 1740715820 |
|---|---|
| Provider Enumeration Date | 04/26/2017 |
| Last Update Date | 08/29/2022 |
| Medicare PECOS PAC ID | 6103213483 |
|---|---|
| Medicare Enrollment ID | O20220505001314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740715820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jose F Vallejo-manzur |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1447396015 PECOS PAC ID: 0547310914 Enrollment ID: I20090604000588 |
| Provider Name | German Luy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427260132 PECOS PAC ID: 6800928961 Enrollment ID: I20100726000216 |
| Provider Name | Juan Chavez Paz |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1104003607 PECOS PAC ID: 4587832035 Enrollment ID: I20110727000690 |
| Provider Name | Antonio De Gorordo Arzamendi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1497890198 PECOS PAC ID: 2365698552 Enrollment ID: I20120802000671 |
| Provider Name | Juan Pablo Sarmiento |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1568625432 PECOS PAC ID: 2668784471 Enrollment ID: I20150708001542 |
| Provider Name | Manuel Ramos Ramirez |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1790190296 PECOS PAC ID: 5395046296 Enrollment ID: I20190506002501 |
| Provider Name | Cruz Garza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477014132 PECOS PAC ID: 6204167737 Enrollment ID: I20191014002236 |
| Provider Name | Adolfo Arteaga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003473638 PECOS PAC ID: 0840625596 Enrollment ID: I20200127001756 |
| Provider Name | Kathryn Lai |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1588079529 PECOS PAC ID: 8820383771 Enrollment ID: I20200727001084 |
| Provider Name | Susan N Moruri |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1306006861 PECOS PAC ID: 4981621059 Enrollment ID: I20200929002822 |
| Provider Name | Jayanth K Lakshmikanth |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1508271404 PECOS PAC ID: 1052683752 Enrollment ID: I20201008003089 |
| Provider Name | David London |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1326425182 PECOS PAC ID: 9436551058 Enrollment ID: I20210706000789 |
| Provider Name | Praveen Vijhani |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1841545852 PECOS PAC ID: 7214283407 Enrollment ID: I20210723000607 |
| Provider Name | Andrew Warejko Phillips |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770849820 PECOS PAC ID: 7214247808 Enrollment ID: I20211116003205 |
| Provider Name | Mark Jon Pamer |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1184824542 PECOS PAC ID: 3971649526 Enrollment ID: I20220126000884 |
| Provider Name | Kayla Denise Delapena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720735533 PECOS PAC ID: 2163819194 Enrollment ID: I20220421002206 |
| Provider Name | Terence Wayne Potter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639590383 PECOS PAC ID: 6002045903 Enrollment ID: I20230510002999 |
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