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General NPI Number Information
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NPI Number | 1265634083
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Entity Type | Organization
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Legal Business Name | EXECUTIVE MEDICAL CLINIC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2601 HOSPITAL BLVD STE 117
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City | CORPUS CHRISTI
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State | TX
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Zip | 78405-1815
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Country | US
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Telephone | 361-884-8209
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Fax | 361-882-6649
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Provider Business Mailing Address
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Address Line | 2601 HOSPITAL BLVD STE 117
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City | CORPUS CHRISTI
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State | TX
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Zip | 78405-1815
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Country | US
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Telephone | 361-884-8209
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Fax | 361-882-6649
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. C.J. BURGIN
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Credential |
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Telephone | 210-767-9042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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