Provider Demographics
NPI:1275783888
Name:SOUTH TEXAS INNOVATIVE MEDICINE
Entity Type:Organization
Organization Name:SOUTH TEXAS INNOVATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-992-9432
Mailing Address - Street 1:5833 SPOHN DR
Mailing Address - Street 2:401
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4135
Mailing Address - Country:US
Mailing Address - Phone:361-992-9432
Mailing Address - Fax:361-992-3978
Practice Address - Street 1:5833 SPOHN DR
Practice Address - Street 2:401
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4135
Practice Address - Country:US
Practice Address - Phone:361-992-9432
Practice Address - Fax:361-992-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00485213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00N940Medicare UPIN