Provider Demographics
NPI:1194786376
Name:DEPARTMENT OF ANESTHESIOLOGY-CORPUS CHRISTI
Entity type:Organization
Organization Name:DEPARTMENT OF ANESTHESIOLOGY-CORPUS CHRISTI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIA SERVICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-694-4449
Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-5445
Mailing Address - Fax:361-694-5449
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5445
Practice Address - Fax:361-694-5449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTMB FACULTY GROUP PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHV49OtherBLUE CROSS/BLUE SHIELD
KS1003788860Medicaid
TX112837302Medicaid
TX00HV49Medicare UPIN