=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295715266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORRIDOR MEDICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2006
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 783 LOOP 337
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-392-4411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 643
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78667-0643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-392-4411
-----------------------------------------------------
Fax | 512-395-8924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | STEPHEN R NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-392-4411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number | FTV018
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number | 459874
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------