1972933604 NPI number — OB-GYN SURGICAL ASSIST

Table of content: (NPI 1972933604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972933604 NPI number — OB-GYN SURGICAL ASSIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OB-GYN SURGICAL ASSIST
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:
1972933604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71092
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:
78467-1092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-249-8204
Provider Business Mailing Address Fax Number:
888-329-6432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 W VANDERBILT DR
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:
78415-4735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-249-8204
Provider Business Practice Location Address Fax Number:
888-329-6432
Provider Enumeration Date:
11/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AVALOS
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-731-0313

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X , with the licence number:  670385 , 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)