Provider Demographics
NPI:1619016664
Name:SOUTHSIDE WOMEN'S CENTER, P.A.
Entity Type:Organization
Organization Name:SOUTHSIDE WOMEN'S CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-985-8100
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-985-8164
Mailing Address - Fax:361-985-8131
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 570
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-985-8100
Practice Address - Fax:361-985-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083779101Medicaid