Basic Information
| Provider Information | |||||||||
| NPI: | 1295261337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PADRE ISLAND ER PHYSICIANS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 S KIMBALL AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760929016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174210012 | ||||||||
| FaxNumber: | 8174210036 | ||||||||
| Practice Location | |||||||||
| Address1: | 14433 S PADRE ISLAND DR | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784185938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174210012 | ||||||||
| FaxNumber: | 8174210036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | NEIMAN | ||||||||
| AuthorizedOfficialFirstName: | BRAXTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 8174210034 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.