Provider Demographics
NPI:1487074050
Name:DR. DIAGNE PREMIER OB GYN PA
Entity type:Organization
Organization Name:DR. DIAGNE PREMIER OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CREDENTIALING OFIICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUEHAYNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-205-3630
Mailing Address - Street 1:PO BOX 3217
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3217
Mailing Address - Country:US
Mailing Address - Phone:956-800-4378
Mailing Address - Fax:956-800-4379
Practice Address - Street 1:4422 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9608
Practice Address - Country:US
Practice Address - Phone:956-800-4378
Practice Address - Fax:956-800-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty