Provider Demographics
NPI:1013049048
Name:ADRIANA POP-MOODY MD CLINIC PLLC
Entity Type:Organization
Organization Name:ADRIANA POP-MOODY MD CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-424-2200
Mailing Address - Street 1:PO BOX 3806
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3806
Mailing Address - Country:US
Mailing Address - Phone:361-885-0010
Mailing Address - Fax:361-885-0001
Practice Address - Street 1:613 ELIZABETH ST
Practice Address - Street 2:SUITE 704
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-885-0010
Practice Address - Fax:361-885-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171094901Medicaid
TX171094901Medicaid