Provider Demographics
NPI:1699087650
Name:SPI CLINIC, PLLC
Entity type:Organization
Organization Name:SPI CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYKA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPMA
Authorized Official - Phone:956-546-3116
Mailing Address - Street 1:425 E LOS EBANOS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8481
Mailing Address - Country:US
Mailing Address - Phone:956-546-3116
Mailing Address - Fax:956-546-8793
Practice Address - Street 1:3808 PADRE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597
Practice Address - Country:US
Practice Address - Phone:956-761-3996
Practice Address - Fax:956-791-6635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ASSOCIATES OF BROWNSVILLE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-07
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080669701Medicaid
TX080669701Medicaid