Provider Demographics
NPI:1760521439
Name:CORPUS CHRISTI CARDIOVASCULAR IMAGING, LP
Entity Type:Organization
Organization Name:CORPUS CHRISTI CARDIOVASCULAR IMAGING, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BETO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CMPE
Authorized Official - Phone:361-888-8271
Mailing Address - Street 1:1521 S STAPLES ST STE 500
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3150
Mailing Address - Country:US
Mailing Address - Phone:361-888-8271
Mailing Address - Fax:361-885-3699
Practice Address - Street 1:1521 S STAPLES ST STE 102
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3159
Practice Address - Country:US
Practice Address - Phone:361-888-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088004903Medicaid
TXFTK021Medicare PIN