Organization
ST MARIE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDUARDO CARRLLO MD (OWNER/CEO)
(956) 583-7744
Entity
Organization
Contact information
Practice address
10900 N 103RD ST, MISSION, TX 78573-0979
(956) 583-7744
(956) 583-7747
Mailing address
305 E EXPRESSWAY 83, MISSION, TX 78572-5560
(956) 585-7401
(956) 580-1788
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
676630
MEDICARE PROVIDER #
TX
Enumeration date
08/14/2006
Last updated
01/16/2009
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