Provider Demographics
NPI:1821043993
Name:CORPUS CHRISTI UROLOGY GROUP PLLC
Entity Type:Organization
Organization Name:CORPUS CHRISTI UROLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-6381
Mailing Address - Street 1:601 TEXAN TRL
Mailing Address - Street 2:STE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2547
Mailing Address - Country:US
Mailing Address - Phone:361-884-6381
Mailing Address - Fax:361-882-7716
Practice Address - Street 1:601 TEXAN TRL
Practice Address - Street 2:STE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2547
Practice Address - Country:US
Practice Address - Phone:361-884-6381
Practice Address - Fax:361-882-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083317002Medicaid
TX083317002Medicaid
TX00JH48Medicare PIN