Provider Demographics
NPI:1700073566
Name:ABC PLASTIC SURGERY CENTER PA
Entity Type:Organization
Organization Name:ABC PLASTIC SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:SAIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-9575
Mailing Address - Street 1:1521 S STAPLES ST
Mailing Address - Street 2:STE 404
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3150
Mailing Address - Country:US
Mailing Address - Phone:361-884-9575
Mailing Address - Fax:361-884-9586
Practice Address - Street 1:1521 S STAPLES ST
Practice Address - Street 2:STE 404
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3150
Practice Address - Country:US
Practice Address - Phone:361-884-9575
Practice Address - Fax:361-884-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2470261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ00828K8Medicaid
TXZ00828K8Medicaid