MEDICARE: ABDOMINAL SPECIALISTS OF SOUTH TEXAS, LLP

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

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

General Provider Information

NPI Number	:	1730159104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABDOMINAL SPECIALISTS OF SOUTH TEXAS, LLP

Provider Business Mailing Address
First Line	:	718 ELIZABETH ST
Second Line	:	FLOOR 3
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-2212
Country	:	US
Telephone Number	:	361-884-2858
Fax Number	:	361-879-9015

Provider Business Practice Location Address
First Line	:	718 ELIZABETH ST
Second Line	:	FLOOR 3
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-2212
Country	:	US
Telephone Number	:	361-884-2858
Fax Number	:	361-879-9015

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MS. BELINDA CHISM
Credential	:
Telephone Number	:	361-884-2858

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	11/16/2016

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