Provider Demographics
NPI:1013994847
Name:THOMAS-SPANN CLINIC, P.A.
Entity Type:Organization
Organization Name:THOMAS-SPANN CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-696-6200
Mailing Address - Street 1:PO BOX 6409
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6409
Mailing Address - Country:US
Mailing Address - Phone:361-696-6200
Mailing Address - Fax:361-696-6054
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:STE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-696-6200
Practice Address - Fax:361-696-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8359OtherMEDICARE