Provider Demographics
NPI:1922084227
Name:THOMAS SPANN CLINIC, PA
Entity Type:Organization
Organization Name:THOMAS SPANN CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER(CFO)
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:361-696-6090
Mailing Address - Street 1:7121 SOUTH PADRE ISLAND DRIVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4940
Mailing Address - Country:US
Mailing Address - Phone:361-696-6043
Mailing Address - Fax:361-696-6060
Practice Address - Street 1:7121 SOUTH PADRE ISLAND DRIVE
Practice Address - Street 2:STE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-696-6043
Practice Address - Fax:361-696-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6277290001Medicare NSC