Provider Demographics
NPI:1427170075
Name:SOUTH TEXAS PSYCHIATRIC ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SOUTH TEXAS PSYCHIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-857-2090
Mailing Address - Street 1:4234 WEBER ROAD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3603
Mailing Address - Country:US
Mailing Address - Phone:361-857-2090
Mailing Address - Fax:361-814-6302
Practice Address - Street 1:4234 WEBER ROAD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3603
Practice Address - Country:US
Practice Address - Phone:361-857-2090
Practice Address - Fax:361-814-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139785308Medicaid
TX139860409Medicaid
TX139850509Medicaid
TX084259301Medicaid
TX139860409Medicaid