1609831296 NPI number — CORPUS CHRISTI SURGERY LTD

Table of content: (NPI 1609831296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609831296 NPI number — CORPUS CHRISTI SURGERY LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPUS CHRISTI SURGERY LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SURGICARE OF CORPUS CHRISTI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609831296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 ELIZABETH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78404-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-882-3204
Provider Business Mailing Address Fax Number:
361-886-6322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 ELIZABETH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-882-3204
Provider Business Practice Location Address Fax Number:
361-886-6322
Provider Enumeration Date:
04/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOOLVERTON
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
361-882-3204

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008393 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)