Provider Demographics
NPI:1841634912
Name:CITY OF CORPUS CHRISTI U S REV
Entity type:Organization
Organization Name:CITY OF CORPUS CHRISTI U S REV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-826-7200
Mailing Address - Street 1:1702 HORNE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1902
Mailing Address - Country:US
Mailing Address - Phone:361-826-7200
Mailing Address - Fax:361-826-7212
Practice Address - Street 1:710 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-3133
Practice Address - Country:US
Practice Address - Phone:361-826-7200
Practice Address - Fax:361-826-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X716Medicare PIN