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General NPI Number Information
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NPI Number | 1093105934
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Entity Type | Organization
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Legal Business Name | KID'S CLINIC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 7017 SOUTH TEXAS
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413
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Country | US
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Telephone | 361-994-7255
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Fax |
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Provider Business Mailing Address
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Address Line | 7017 SOUTH TEXAS
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | DR. WILLIAM FADER
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Credential | M.D.
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Telephone | 361-994-7255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | F0613622
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License Number State | TX
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