Provider Demographics
NPI:1659808269
Name:USCG CLINIC CORPUS CHRISTI
Entity Type:Organization
Organization Name:USCG CLINIC CORPUS CHRISTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SYSTEMS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-628-4363
Mailing Address - Street 1:8930 OCEAN DRIVE, HGR 41
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78419
Mailing Address - Country:US
Mailing Address - Phone:316-939-6379
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1753
Practice Address - Country:US
Practice Address - Phone:757-628-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient