Provider Demographics
NPI:1427177377
Name:COLON AND RECTAL ASSOCIATES OF SOUTH TEXAS
Entity type:Organization
Organization Name:COLON AND RECTAL ASSOCIATES OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MICAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-883-3831
Mailing Address - Street 1:613 ELIZABETH ST STE 809
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2232
Mailing Address - Country:US
Mailing Address - Phone:361-883-3831
Mailing Address - Fax:361-887-0146
Practice Address - Street 1:613 ELIZABETH ST STE 809
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2232
Practice Address - Country:US
Practice Address - Phone:361-883-3831
Practice Address - Fax:361-887-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7836208C00000X
TXG9395208C00000X
TXM0423208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101550502Medicaid
TX172277901Medicaid
TX114250703Medicaid
TXF77690Medicare UPIN
TXH69790Medicare UPIN
TX114250703Medicaid
TX172277901Medicaid
TXB21446Medicare UPIN
TX80W662Medicare PIN