MEDICARE: SOUTH PADRE ISLAND PEDIATRIC CENTER PA

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	261QR1300X	Rural Health Clinic/Center	G6791	TX
2	261QR1300X	Rural Health Clinic/Center	E4618	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

General Provider Information

NPI Number	:	1720233687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PADRE ISLAND PEDIATRIC CENTER PA

Provider Business Mailing Address
First Line	:	301 S SAN PATRICIO ST
Second Line	:
City	:	SINTON
State	:	TX
Zip	:	78387-2432
Country	:	US
Telephone Number	:	361-364-3355
Fax Number	:	361-851-5193

Provider Business Practice Location Address
First Line	:	301 S SAN PATRICIO ST
Second Line	:
City	:	SINTON
State	:	TX
Zip	:	78387-2432
Country	:	US
Telephone Number	:	361-364-3355
Fax Number	:	361-851-5193

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SANDY GONZALEZ
Credential	:
Telephone Number	:	361-225-1055

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	01/27/2026

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Directions to “SOUTH PADRE ISLAND PEDIATRIC CENTER PA ” Practice Location

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