Provider Demographics
NPI:1447857255
Name:FAIRGROUNDS FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:FAIRGROUNDS FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, CO- OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAYAO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:956-622-0554
Mailing Address - Street 1:300 SHORT ST.
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559
Mailing Address - Country:US
Mailing Address - Phone:956-277-0113
Mailing Address - Fax:
Practice Address - Street 1:300 SHORT ST.
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559
Practice Address - Country:US
Practice Address - Phone:956-277-0113
Practice Address - Fax:956-277-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care