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General NPI Number Information
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NPI Number | 1538035035
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Entity Type | Organization
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Legal Business Name | SOUTH PADRE ISLAND PEDIATRIC CLINIC PA
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1210 GREGORY ST STE 2
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City | TAFT
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State | TX
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Zip | 78390-3045
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Country | US
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Telephone | 361-528-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 3845 S PADRE ISLAND DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78415-2919
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Country | US
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Telephone | 361-854-4626
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Fax | 361-851-5193
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | THERESA POWELL
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Credential |
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Telephone | 361-854-4626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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