Provider Demographics
NPI:1649473992
Name:RODNEY S. CARLSON
Entity type:Organization
Organization Name:RODNEY S. CARLSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-683-9166
Mailing Address - Street 1:2017 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3861
Mailing Address - Country:US
Mailing Address - Phone:956-683-9166
Mailing Address - Fax:956-631-4476
Practice Address - Street 1:1521 TRENTON RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3146
Practice Address - Country:US
Practice Address - Phone:956-631-4466
Practice Address - Fax:956-631-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization