NPIMap

Organization Active NPI

St Marie Clinic P a

  • Family Medicine Physician
  • Mission, TX
National Provider Identifier
1396764577
Registry record updated Dec 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST MARIE CLINIC P A
Practice address
305 E Expressway 83
Mission, TX 78572-5560
Phone
(956) 585-7401
Fax
(956) 583-5833
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 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 1

IdentifierTypeStateIssuer
168788102MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1396764577",
    "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": "956-583-5833"
        },
        {
            "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": "956-585-7401",
            "fax_number": "956-583-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARIE CLINIC P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "956-585-7401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168788102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 29, 2009; 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.