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Organization

IRIS WELL CHILD PHYSICALS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
IRIS GARCIA R.N., PNP (OWNER)
(956) 262-9805
Entity
Organization

Contact information

Practice address
200 W. EDINBURG HWY 107, SUITE B, ELSA, TX 78543-1274
(956) 262-9805
(956) 262-9233
Mailing address
PO BOX 1274, ELSA, TX 78543-1274
(956) 262-9805
(956) 262-9233

Taxonomy

Speciality
Code
Description
License number
State
364SP0200X
Pediatric Clinical Nurse Specialist
Primary
533197
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
121084101
TX
01
121084102
MEDICAID-EPSDT
TX
01
121392
SUPERIOR HEALTHPLAN NETWORK
TX
01
8N8564
BLUE CROSS BLUE SHIELD OF TEXAS
TX
Enumeration date
02/20/2009
Last updated
02/20/2009
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