Provider Demographics
NPI:1003845108
Name:CITY OF CORPUS CHRISTI
Entity Type:Organization
Organization Name:CITY OF CORPUS CHRISTI
Other - Org Name:CORPUS CHRISTI-NUECES COUNTY PUBLIC HEALTH DISTRICT LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEATHERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH MT(ASCP)
Authorized Official - Phone:361-851-7214
Mailing Address - Street 1:1201 LEOPARD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401
Mailing Address - Country:US
Mailing Address - Phone:361-826-1303
Mailing Address - Fax:361-826-7212
Practice Address - Street 1:1702 HORNERD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416
Practice Address - Country:US
Practice Address - Phone:361-826-1303
Practice Address - Fax:361-826-7212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CORPUS CHRISTI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC139382083P0901X, 251K00000X, 291U00000X
251K00000X
TX45D0660522291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130958501Medicaid
TX130958504Medicaid
TX130958509Medicaid
TX130958510Medicaid
TX130958502Medicaid
TX130958503Medicaid
TX130958505Medicaid
TX130958508Medicaid