PALOMA HEALTHCARE LLC , NPI 1003900838 — BROWNSVILLE (TX)

NPI 1003900838

14+ Years Experience Organization

PALOMA HEALTHCARE LLC

10.03.2006
PROVIDER ENUMERATION DATE
07.09.2007
LAST UPDATE DATE
1003900838
NPI NUMBER

About PALOMA HEALTHCARE LLC

PALOMA HEALTHCARE LLC is a provider established in BROWNSVILLE, TX. The NPI number of PALOMA HEALTHCARE LLC is 1003900838 and was assigned on 10.03.2006. The practitioners primary taxonomy code is: 261QR0200X .

Mailing address

  • City: BROWNSVILLE
  • State: TX
  • Postal code: 78520
  • Phone: 9565419797
  • Fax: 9565419393
  • Address: 864 CENTRAL BLVD., STE 200

Primary Practice Address

  • Region : BROWNSVILLE, TX
  • NPI : 1003900838
  • Phone : 9565419797
  • Fax : 9565419393
  • Postalcode : 78520
  • Address : 864 CENTRAL BLVD., STE 200

Additional identifiers

  • Identifier: 0247DC
  • Code / Type : 1 - other
  • Identifier state : TX
  • Identifier issuer: BCBS PROVIDER NUMBER

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 4565098
  • Code / Type : 1 - other
  • Identifier state : TX
  • Identifier issuer : AETNA PROVIDER NUMBER

Provider taxonomy - Clinic/Center

  • Taxonomy code: 261QR0200X

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • PALOMA HEALTHCARE LLC
  • Address : 864 CENTRAL BLVD., STE 200
  • Region : BROWNSVILLE, TX
  • NPI : 1003900838
  • Phone : 9565419797
  • Fax : 9565419393
  • Postalcode : 78520

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 9565419797
  • Title or position : BUSINESS MANAGER

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address864 CENTRAL BLVD., STE 200
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameBROWNSVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameTX
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code78520
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number9565419797
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number9565419393
The fax number associated with the location address of the provider being identified.
NPI1003900838
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1261QR0200X
Provider Enumeration Date10.03.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.09.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)PALOMA HEALTHCARE LLC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address864 CENTRAL BLVD., STE 200
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameBROWNSVILLE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameTX
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code78520
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number9565419797
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number9565419393
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameRUIZ
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameMARY
The first name of the authorized official
Authorized Official Title or PositionBUSINESS MANAGER
The title or position of the authorized official
Authorized Official Telephone Number9565419797
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1261QR0200X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Clinic/Center
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 10247DC
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1TX
Other Provider Identifier State #1
Other Provider Identifier Issuer 1BCBS PROVIDER NUMBER
Other Provider Identifier Issuer #1
Other Provider Identifier 24565098
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2TX
Other Provider Identifier State #2
Other Provider Identifier Issuer 2AETNA PROVIDER NUMBER
Other Provider Identifier Issuer #2
X

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