Provider Demographics
NPI:1033436571
Name:DRISCOLL PHYSICIANS GROUP
Entity Type:Organization
Organization Name:DRISCOLL PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDICATRIC CARDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-694-5086
Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-5086
Mailing Address - Fax:361-855-9518
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5086
Practice Address - Fax:361-855-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10042080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN39221Medicaid
TX2179756Medicaid
NC7979737Medicaid
SCE612388186Medicare PIN
TX2179756Medicaid
TXTXB110370Medicare PIN
NC2155524DMedicare PIN