Provider Demographics
NPI:1134203813
Name:BERNARDO OLAYA M.D. PA
Entity type:Organization
Organization Name:BERNARDO OLAYA M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:940-766-6500
Mailing Address - Street 1:PO BOX 4106
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0106
Mailing Address - Country:US
Mailing Address - Phone:940-766-6500
Mailing Address - Fax:940-766-6506
Practice Address - Street 1:2211 MIDWESTERN PKWY STE 3
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2300
Practice Address - Country:US
Practice Address - Phone:940-766-6500
Practice Address - Fax:940-766-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111702004Medicaid
TXB8740OtherTEXAS LICENSE
TX0046MBOtherBCBS
TX0046MBOtherBCBS
TX111702004Medicaid
TXTXB111686Medicare PIN
611481Medicare PIN
TXA09471373OtherDEA