Healthcare Provider Details

I. General information

NPI: 1821224098
Provider Name (Legal Business Name): MATHIS MEDICAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E SAN PATRICIO AVE
MATHIS TX
78368-2350
US

IV. Provider business mailing address

5920 SARATOGA BLVD STE 420
CORPUS CHRISTI TX
78414-4103
US

V. Phone/Fax

Practice location:
  • Phone: 361-991-0112
  • Fax: 361-991-0181
Mailing address:
  • Phone: 361-991-0112
  • Fax: 361-991-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberJ9719
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberJ9719
License Number StateTX

VIII. Authorized Official

Name: HAITHAM JIFI
Title or Position: DOCTOR
Credential: MD
Phone: 361-991-0112