Provider Demographics
NPI:1528015096
Name:DRISCOLL PHYSICIANS GROUP
Entity Type:Organization
Organization Name:DRISCOLL PHYSICIANS GROUP
Other - Org Name:DRISCOLL PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-694-5082
Mailing Address - Street 1:3533 SOUTH ALAMEDA SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-5082
Mailing Address - Fax:361-694-4641
Practice Address - Street 1:3533 SOUTH ALAMEDA SUITE H-100
Practice Address - Street 2:
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:2006-05-28
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030JYOtherBCBSTX
TX159306301Medicaid
TX0030JYOtherBCBSTX