Provider Demographics
NPI:1033175039
Name:STEVEN E. NOWOTNY, D.O., P.A.
Entity Type:Organization
Organization Name:STEVEN E. NOWOTNY, D.O., P.A.
Other - Org Name:PORT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NOWOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-993-1747
Mailing Address - Street 1:4818 HOLLY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4734
Mailing Address - Country:US
Mailing Address - Phone:361-993-1747
Mailing Address - Fax:361-749-4638
Practice Address - Street 1:4818 HOLLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4734
Practice Address - Country:US
Practice Address - Phone:361-993-1747
Practice Address - Fax:361-991-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154960202Medicaid
TXH51346Medicare UPIN
TX00275UMedicare PIN