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General NPI Number Information
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NPI Number | 1730369802
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Entity Type | Organization
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Legal Business Name | SHORELINE SURGERY CENTER LLP
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 718 ELIZABETH ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-2212
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Country | US
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Telephone | 361-882-3204
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Fax | 361-886-6322
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Provider Business Mailing Address
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Address Line | 718 ELIZABETH ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-2212
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Country | US
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Telephone | 361-882-3204
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Fax | 361-886-6322
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | PETER BLACH
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Credential |
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Telephone | 713-343-9083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008393
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License Number State | TX
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