Provider Demographics
NPI:1942738455
Name:OAK RUN ER, PLLC
Entity Type:Organization
Organization Name:OAK RUN ER, PLLC
Other - Org Name:CORNERSTONE DOCTORS, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PLLC MEMBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NISBET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-625-0911
Mailing Address - Street 1:PO BOX 6056
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6056
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:512-852-4625
Practice Address - Street 1:1850 W STATE HIGHWAY 46 STE 109
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5283
Practice Address - Country:US
Practice Address - Phone:830-625-0913
Practice Address - Fax:512-852-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-28
Last Update Date:2017-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160317261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care