=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407127384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEWITT MEDICAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2012
-----------------------------------------------------
Last Update Date | 08/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 FIG ST
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78404-3834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-888-5619
-----------------------------------------------------
Fax | 361-888-5819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 N ESPLANADE ST
-----------------------------------------------------
City | CUERO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77954-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-275-6191
-----------------------------------------------------
Fax | 361-275-3999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | ALMA ALEXANDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 361-275-6191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------