MEDICARE: CITY OF CORPUS CHRISTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	45D0660522	TX
2	251K00000X	Public Health or Welfare Agency
3	2083P0901X	Public Health & General Preventive Medicine Physician	C13938	TX
4	251K00000X	Public Health or Welfare Agency	C13938	TX
5	291U00000X	Clinical Medical Laboratory	C13938	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003845108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CORPUS CHRISTI

Provider Business Mailing Address
First Line	:	1201 LEOPARD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78401
Country	:	US
Telephone Number	:	361-826-1303
Fax Number	:	361-826-7212

Provider Business Practice Location Address
First Line	:	1702 HORNERD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416
Country	:	US
Telephone Number	:	361-826-1303
Fax Number	:	361-826-7212

Authorized Official
Title or Position	:	DIVISION DIRECTOR
Name	:	MS. SANDRA S HEATHERLEY
Credential	:	M.P.H. MT(ASCP)
Telephone Number	:	361-851-7214

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	12/20/2011

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Directions to “CITY OF CORPUS CHRISTI ” Practice Location

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