Provider Demographics
NPI:1639303910
Name:PEDIATRIC SURGICAL SPECIALISTS OF SOUTH TEXAS LLP
Entity Type:Organization
Organization Name:PEDIATRIC SURGICAL SPECIALISTS OF SOUTH TEXAS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-854-0201
Mailing Address - Street 1:PO BOX 30104
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-0104
Mailing Address - Country:US
Mailing Address - Phone:361-854-0201
Mailing Address - Fax:361-855-7572
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:SUITE 209
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-854-0201
Practice Address - Fax:361-855-7572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM00192080P0202X
TXJ5418208G00000X
TXL1528208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty