Provider Demographics
NPI:1356858468
Name:ADRIANA POP-MOODY MD CLINIC PA
Entity Type:Organization
Organization Name:ADRIANA POP-MOODY MD CLINIC PA
Other - Org Name:CORPUS CHRISTI RHEUMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-510-9726
Mailing Address - Street 1:PO BOX 3806
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3806
Mailing Address - Country:US
Mailing Address - Phone:361-885-0010
Mailing Address - Fax:361-885-0001
Practice Address - Street 1:613 ELIZABETH ST STE 703A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-885-0010
Practice Address - Fax:361-885-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX317013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173291OtherPK