Healthcare Provider Details

I. General information

NPI: 1336771062
Provider Name (Legal Business Name): FIRST ASSISTANTS OF SOUTH TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6256 LEMANS DR
CORPUS CHRISTI TX
78414-6131
US

IV. Provider business mailing address

6256 LEMANS DR
CORPUS CHRISTI TX
78414-6131
US

V. Phone/Fax

Practice location:
  • Phone: 361-537-3209
  • Fax: 361-336-0217
Mailing address:
  • Phone: 361-537-3209
  • Fax: 361-336-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JACOB D SKORUPPA
Title or Position: PRESIDENT
Credential:
Phone: 361-537-3209