Provider Demographics
NPI:1154434579
Name:ABDOMINAL SPECIALISTS OF SOUTH TEXAS
Entity type:Organization
Organization Name:ABDOMINAL SPECIALISTS OF SOUTH TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-884-2858
Mailing Address - Street 1:1301 OCEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2206
Mailing Address - Country:US
Mailing Address - Phone:361-884-2858
Mailing Address - Fax:361-879-9009
Practice Address - Street 1:1301 OCEAN DRIVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2206
Practice Address - Country:US
Practice Address - Phone:361-884-2858
Practice Address - Fax:361-879-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000260OtherLICENSE
TX000260OtherLICENSE