Healthcare Provider Details

I. General information

NPI: 1710090089
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1630
US

IV. Provider business mailing address

601 TEXAN TRL STE. 300
CORPUS CHRISTI TX
78411-2549
US

V. Phone/Fax

Practice location:
  • Phone: 361-561-0635
  • Fax: 361-806-5033
Mailing address:
  • Phone: 361-854-0811
  • Fax: 361-806-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES WILLIAM BRECKENRIDGE
Title or Position: PRESIDENT - OACC
Credential: M.D.
Phone: 361-854-0811