NPIMap

Organization Active NPI

St. Marie Clinic, P.a.

  • Clinic Pharmacy
  • Mission, TX
National Provider Identifier
1104919216
Registry record updated Aug 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
45-37380 Issued in TX
Legal business name
ST. MARIE CLINIC, P.A.
Practice address
305 E Expressway 83
Mission, TX 78572-5560
Phone
(956) 585-2009
Fax
(956) 583-5833
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eduardo Carrillo, MD
Title
Ceo/Owner
Phone
(956) 585-7401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 45-37380 TX Primary

Addresses

Primary practice location

305 E Expressway 83
Mission, TX 78572-5560

Mailing address

305 E Expressway 83
Mission, TX 78572-5560
Phone (956) 585-7401

Other identifiers 2

IdentifierTypeStateIssuer
145560OtherTXVENDOR DRUG NUMBER
45-37380OtherTXNCPDP NUMBER

Other names 1

  • St. Marie Clinic, P.A. Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

607 E Coma Ave
Ste C
Hidalgo, TX 78557
Phone (956) 843-2332

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218672000000",
    "number": "1104919216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E EXPRESSWAY 83",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785725560",
            "telephone_number": "956-585-7401",
            "fax_number": "956-580-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E EXPRESSWAY 83",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785725560",
            "telephone_number": "956-585-2009",
            "fax_number": "956-583-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARIE CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-08-14",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "956-585-7401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TX",
            "license": "45-37380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VENDOR DRUG NUMBER",
            "identifier": "145560",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "45-37380",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Marie Clinic, P.A. Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mission, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.