Provider Demographics
NPI:1356514459
Name:MENDEZ MEDICAL CONSULTING, PC
Entity type:Organization
Organization Name:MENDEZ MEDICAL CONSULTING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESPIRIDION
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-337-8297
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:VAN HORN
Mailing Address - State:TX
Mailing Address - Zip Code:79855
Mailing Address - Country:US
Mailing Address - Phone:719-337-8297
Mailing Address - Fax:877-808-1820
Practice Address - Street 1:404 SOWELL STREET
Practice Address - Street 2:
Practice Address - City:VAN HORN
Practice Address - State:TX
Practice Address - Zip Code:79855
Practice Address - Country:US
Practice Address - Phone:719-337-8297
Practice Address - Fax:877-808-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory