Provider Demographics
NPI:1679606636
Name:NEUROSURGERY INSTITUTE OF SOUTH TEXAS
Entity Type:Organization
Organization Name:NEUROSURGERY INSTITUTE OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSABELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:3615-611-1387
Mailing Address - Street 1:3643 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2456
Mailing Address - Country:US
Mailing Address - Phone:361-561-1387
Mailing Address - Fax:
Practice Address - Street 1:3643 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2456
Practice Address - Country:US
Practice Address - Phone:361-561-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09-5061001Medicaid