Provider Demographics
NPI:1235170283
Name:ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Other - Org Name:SOUTH TEXAS BONE AND JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF OACC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRECKENRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-854-0811
Mailing Address - Street 1:5917 CROSSTOWN EXPRESSWAY SH 286
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78417
Mailing Address - Country:US
Mailing Address - Phone:361-854-0811
Mailing Address - Fax:361-806-5040
Practice Address - Street 1:5917 CROSSTOWN EXPRESSWAY SH 286
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78417
Practice Address - Country:US
Practice Address - Phone:361-854-0811
Practice Address - Fax:361-806-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1126369-07Medicaid
TX1126369-07Medicaid