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KIDS CLINIC PA NPI 1376767913


NPI Information

NPI: 1376767913
Provider Name: KIDS CLINIC PA
Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization

CLIA Number: 45D0916617

Address:
7017 S STAPLES ST
STE 101
CORPUS CHRISTI, TX
ZIP 78413
Phone: (361) 994-7255
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KIDS CLINIC PA is a preferred provider organization in Corpus Christi, TX. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. KIDS CLINIC PA NPI is 1376767913. The provider is registered as an organization entity type.

The provider's business location address is:

7017 S STAPLES ST
STE 101
CORPUS CHRISTI, TX
ZIP 78413-507
Phone: (361) 994-7255
Fax: (361) 994-7740

The provider's authorized official is William A Fader .
The authorized official title is Physician and has the following contact phone number (361) 994-7255.

The CLIA number assigned to this NPI record is 45D0916617 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/13/2007 and was last updated on 8/29/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider OrganizationH3035TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1121271401MEDICAIDTEXAS
2121271404MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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