Provider Demographics
NPI:1578564043
Name:OBSTETRICAL & GYNECOLOGICAL ASSOCIATES OF CORPUS CHRISTI
Entity Type:Organization
Organization Name:OBSTETRICAL & GYNECOLOGICAL ASSOCIATES OF CORPUS CHRISTI
Other - Org Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES OF CORPUS CHRISTI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-994-5454
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-994-5454
Mailing Address - Fax:361-994-5455
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:STE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-994-5454
Practice Address - Fax:361-994-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107707501Medicaid
TX00LK34Medicare PIN