Provider Demographics
NPI:1821041815
Name:DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP
Entity Type:Organization
Organization Name:DRISCOLL MATERNAL & FETAL PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-694-5081
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SIITE 110
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-694-1660
Mailing Address - Fax:361-808-2131
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SIITE 110
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-694-1660
Practice Address - Fax:361-808-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171695301Medicaid
TX0082MAOtherBC/BS
TX171695302Medicaid
TX00404YMedicare ID - Type Unspecified
TX00843XMedicare PIN