1588738389 NPI number — WOMEN'S & MEN'S HEALTH SERVICES OF THE COASTAL BEND, INC.

Table of content: (NPI 1588738389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588738389 NPI number — WOMEN'S & MEN'S HEALTH SERVICES OF THE COASTAL BEND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S & MEN'S HEALTH SERVICES OF THE COASTAL BEND, INC.
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:
1588738389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3536 HOLLY RD
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:
78415-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-855-9107
Provider Business Mailing Address Fax Number:
361-855-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 DILLON LN
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78415-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-855-9107
Provider Business Practice Location Address Fax Number:
361-855-6822
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STUKENBERG
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
361-855-9107

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0883308-03 . This is a "TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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