Provider Demographics
NPI:1013947720
Name:ALLERGY AND IMMUNOLOGY SPECIALISTS OF CORPUS CHRISTI, PA
Entity Type:Organization
Organization Name:ALLERGY AND IMMUNOLOGY SPECIALISTS OF CORPUS CHRISTI, PA
Other - Org Name:THE ALLERGY AND ASTHMA CENTER OF CORPUS CHRISTI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-992-8500
Mailing Address - Street 1:1718 BRAESWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4584
Mailing Address - Country:US
Mailing Address - Phone:361-992-8500
Mailing Address - Fax:361-992-6711
Practice Address - Street 1:1718 BRAESWOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4584
Practice Address - Country:US
Practice Address - Phone:361-992-8500
Practice Address - Fax:361-992-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091430101Medicaid
TX091430101Medicaid