Healthcare Provider Details

I. General information

NPI: 1063712636
Provider Name (Legal Business Name): CHCA MAINLAND LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6807 EMMETT F LOWRY EXPY SUITE 305
TEXAS CITY TX
77591-2546
US

IV. Provider business mailing address

6801 EMMETT F LOWRY EXPY
TEXAS CITY TX
77591-2500
US

V. Phone/Fax

Practice location:
  • Phone: 409-934-8687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN CALLAWAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 409-935-5000