Provider Demographics
NPI:1033126818
Name:ADULT MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:ADULT MEDICINE ASSOCIATES
Other - Org Name:SOUTH TEXAS ADULT MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:BUGAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-225-2255
Mailing Address - Street 1:6200 SARATOGA BLVD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3477
Mailing Address - Country:US
Mailing Address - Phone:361-225-2255
Mailing Address - Fax:361-854-3672
Practice Address - Street 1:6200 SARATOGA BLVD
Practice Address - Street 2:BLDG 5
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3477
Practice Address - Country:US
Practice Address - Phone:361-225-2255
Practice Address - Fax:361-854-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080444502Medicaid
H51402Medicare UPIN
B21562Medicare UPIN
B23141Medicare UPIN
TX080444502Medicaid
G93165Medicare UPIN
H66165Medicare UPIN