1710090089 NPI number — ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI

Table of content: (NPI 1710090089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710090089 NPI number — ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
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:
CORPUS CHRISTI MRI CENTER
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:
1710090089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 TEXAN TRL
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78411-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-854-0811
Provider Business Mailing Address Fax Number:
361-806-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3702 S ALAMEDA 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:
78411-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-561-0635
Provider Business Practice Location Address Fax Number:
361-806-5033
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRECKENRIDGE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT - OACC
Authorized Official Telephone Number:
361-854-0811

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1126369-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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