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NPI Code Detail

MEDICARE: DR. CAROL ANN ANDRUS M.D.

MEDICARE: DR. CAROL ANN ANDRUS M.D.
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
1207Q00000XFamily Medicine PhysicianTXK0057TX
2207P00000XEmergency Medicine PhysicianK0057TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K0057OTHERTXSTATE BOARD OF MEDICINE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
330095257OTHERTXDPS

General Provider Information

NPI Number : 1629090899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL ANN ANDRUS M.D.
Provider Business Mailing Address
First Line : 815 N VIRGINIA ST
Second Line :
City : PORT LAVACA
State : TX
Zip : 77979-3025
Country : US
Telephone Number : 361-552-0325
Fax Number : 361-552-5926
Provider Business Practice Location Address
First Line : 1016 N VIRGINIA ST
Second Line :
City : PORT LAVACA
State : TX
Zip : 77979-3000
Country : US
Telephone Number : 361-552-0325
Fax Number : 361-552-5926
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 10/10/2016

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Directions to “ DR. CAROL ANN ANDRUS M.D.” Practice Location

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