MEDICARE: SOUTH PADRE ISLAND PEDIATRIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E4618	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548450190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PADRE ISLAND PEDIATRIC CENTER

Provider Business Mailing Address
First Line	:	3845 S SPID DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2919
Country	:	US
Telephone Number	:	361-854-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3845 S SPID DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2919
Country	:	US
Telephone Number	:	361-854-4626
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MULUKUTLA RAMAKRISHNA
Credential	:	M.D.
Telephone Number	:	361-854-4626

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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Directions to “SOUTH PADRE ISLAND PEDIATRIC CENTER ” Practice Location

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