Provider Demographics
NPI:1053317362
Name:DOCTORS HOSPITAL AT RENAISSANCE, LTD
Entity type:Organization
Organization Name:DOCTORS HOSPITAL AT RENAISSANCE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-362-3065
Mailing Address - Street 1:PO BOX 3293
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3293
Mailing Address - Country:US
Mailing Address - Phone:956-362-8677
Mailing Address - Fax:956-362-3372
Practice Address - Street 1:5501 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9152
Practice Address - Country:US
Practice Address - Phone:956-362-3300
Practice Address - Fax:956-362-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
TX007971282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160709501Medicaid
TX160709504OtherCSHCN
TX160709502Medicaid
TXHH1032OtherBLUE CROSS
TX450869Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER