1871602789 NPI number — CHRISTIAN J HIRSCH M.D. PC

Table of content: CHRISTIAN J HIRSCH M.D. PC (NPI 1871602789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871602789 NPI number — CHRISTIAN J HIRSCH M.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCH
Provider First Name:
CHRISTIAN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D. PC
Provider Gender Code:
M

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:
1871602789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13814 CAPTAIN KIDD DR
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:
78418-6381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-544-1369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3302 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:
78411-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-443-8825
Provider Business Practice Location Address Fax Number:
800-655-2081
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  204067 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208C00000X , with the licence number: T5124 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6C1591 . This is a "HEALTHNET ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P927644 . This is a "OXFORD ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0192217 . This is a "GHI PPO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1733914 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5989636 . This is a "AETNA PPO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01884335 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 463151701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2J6581 . This is a "EMPIRE BCBS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 260874829 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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