Provider Demographics
NPI:1710090089
Name:ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Other - Org Name:CORPUS CHRISTI MRI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT - OACC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRECKENRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-854-0811
Mailing Address - Street 1:601 TEXAN TRL
Mailing Address - Street 2:STE. 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2549
Mailing Address - Country:US
Mailing Address - Phone:361-854-0811
Mailing Address - Fax:361-806-5040
Practice Address - Street 1:3702 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1630
Practice Address - Country:US
Practice Address - Phone:361-561-0635
Practice Address - Fax:361-806-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1126369-04Medicaid
W60933Medicare UPIN
FTX155Medicare PIN