Provider Demographics
NPI:1073627071
Name:PRIMARY & DIAGNOSTIC MEDICAL CENTERS OF TEXAS
Entity Type:Organization
Organization Name:PRIMARY & DIAGNOSTIC MEDICAL CENTERS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-906-2121
Mailing Address - Street 1:PO BOX 271567
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1567
Mailing Address - Country:US
Mailing Address - Phone:361-906-2121
Mailing Address - Fax:361-906-2264
Practice Address - Street 1:3829 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5814
Practice Address - Country:US
Practice Address - Phone:361-906-2121
Practice Address - Fax:361-906-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID