Healthcare Provider Details

I. General information

NPI: 1033357645
Provider Name (Legal Business Name): DRISCOLL CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

3333 S ALAMEDA ST APARTMENT #13P
CORPUS CHRISTI TX
78411-1800
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number520185
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number520185
License Number StateTX

VIII. Authorized Official

Name: WILLIAM DIRKSEN
Title or Position: VICE PRESIDENT OF MEDICAL EDUCATION
Credential:
Phone: 361-694-5464