1679927081 NPI number — CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI-MEMORIAL

Table of content: DR. NEILSON LANE WAGLEY DMD (NPI 1427582964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679927081 NPI number — CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI-MEMORIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI-MEMORIAL
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:
Provider Other Organization Name Type Code:
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:
1679927081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2606 HOSPITAL BLVD
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:
78405-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-902-6570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2606 HOSPITAL BLVD
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:
78405-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-902-6570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MCCREERY
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, GRADUATE MEDICAL EDUCATION
Authorized Official Telephone Number:
361-902-6570

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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