Provider Demographics
NPI:1811140015
Name:PATRICIA P CORKE, MDPA
Entity type:Organization
Organization Name:PATRICIA P CORKE, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-333-5740
Mailing Address - Street 1:18333 EGRET BAY BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3265
Mailing Address - Country:US
Mailing Address - Phone:281-333-5740
Mailing Address - Fax:281-333-4013
Practice Address - Street 1:18333 EGRET BAY BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3265
Practice Address - Country:US
Practice Address - Phone:281-333-5740
Practice Address - Fax:281-333-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4962103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX91MQOtherBLUE CROSS BLUE SHIELD
TX115477501Medicaid
TX115477501Medicaid