Healthcare Provider Details

I. General information

NPI: 1235170283
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5917 CROSSTOWN EXPRESSWAY SH 286
CORPUS CHRISTI TX
78417
US

IV. Provider business mailing address

5917 CROSSTOWN EXPRESSWAY SH 286
CORPUS CHRISTI TX
78417
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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