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SOUTH PADRE ISLAND PEDIATRIC CENTER NPI 1548450190


NPI Information

NPI: 1548450190
Provider Name: SOUTH PADRE ISLAND PEDIATRIC CENTER
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 45D0503140

Address:
3845 S SPID DR
CORPUS CHRISTI, TX
ZIP 78415
Phone: (361) 854-4626
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SOUTH PADRE ISLAND PEDIATRIC CENTER is a specialist in Corpus Christi, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTH PADRE ISLAND PEDIATRIC CENTER NPI is 1548450190. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3845 S SPID DR
CORPUS CHRISTI, TX
ZIP 78415-919
Phone: (361) 854-4626

The provider's authorized official is Mulukutla Ramakrishna .
The authorized official title is President and has the following contact phone number (361) 854-4626.

The CLIA number assigned to this NPI record is 45D0503140 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/30/2007 and was last updated on 7/30/2007.


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
1174400000XSpecialistE4618TEXASYes

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
1645663163MEDICAIDTEXAS
2092694101MEDICAIDTEXAS
3645666168MEDICAIDTEXAS
4127051407MEDICAIDTEXAS
5645665166MEDICAIDTEXAS
6093832601MEDICAIDTEXAS
7127051403MEDICAIDTEXAS
8127051406MEDICAIDTEXAS
9645660168MEDICAIDTEXAS
10127051405MEDICAIDTEXAS
11121157503MEDICAIDTEXAS
12127051404MEDICAIDTEXAS

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.