Organization
VALLEY EAR NOSE & THROAT SPECIALIST PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES THEIVAGT MD (PARTNER/OFFICER)
(956) 687-7896
Entity
Organization
Contact information
Practice address
2101 S CYNTHIA ST, MCALLEN, TX 78503-1294
(956) 687-7896
(956) 994-9694
Mailing address
2101 S CYNTHIA ST, MCALLEN, TX 78503-1294
(956) 687-7896
(956) 994-9694
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
231H00000X
Audiologist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00447N
BC/BS OF TEXAS
TX
05
—
080612703
—
TX
01
—
CD5674
RAILROAD MEDICARE
TX
Enumeration date
06/13/2005
Last updated
10/26/2023
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