Provider Demographics
NPI:1336771062
Name:FIRST ASSISTANTS OF SOUTH TEXAS
Entity Type:Organization
Organization Name:FIRST ASSISTANTS OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKORUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-537-3209
Mailing Address - Street 1:6256 LEMANS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6131
Mailing Address - Country:US
Mailing Address - Phone:361-537-3209
Mailing Address - Fax:361-336-0217
Practice Address - Street 1:6256 LEMANS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6131
Practice Address - Country:US
Practice Address - Phone:361-537-3209
Practice Address - Fax:361-336-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty