Basic Information
| Provider Information | |||||||||
| NPI: | 1326415035 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORPUS CHRISTI HEART CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 3RD ST | ||||||||
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| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784042314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618833962 | ||||||||
| FaxNumber: | 3618836563 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784042314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618833962 | ||||||||
| FaxNumber: | 3618836563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2015 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTSON | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHROIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7138521550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.