Provider Demographics
NPI:1679023840
Name:ABDOMINAL SPECIALISTS OF SOUTH TEXAS, LLP
Entity Type:Organization
Organization Name:ABDOMINAL SPECIALISTS OF SOUTH TEXAS, LLP
Other - Org Name:CRYSTAL CLEAR PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-884-2858
Mailing Address - Street 1:718 ELIZABETH ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2212
Mailing Address - Country:US
Mailing Address - Phone:361-884-2858
Mailing Address - Fax:361-879-9015
Practice Address - Street 1:718 ELIZABETH ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2212
Practice Address - Country:US
Practice Address - Phone:361-884-2858
Practice Address - Fax:361-879-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2116176291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory