Basic Information
| Provider Information | |||||||||
| NPI: | 1366495012 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAY AREA HEALTHCARE GROUP, LTD. | ||||||||
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| OtherOrganizationName: | CORPUS CHRISTI MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8991 | ||||||||
| Address2: | 3315 ALAMEDA | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784688991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617611000 | ||||||||
| FaxNumber: | 3618575960 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 S PADRE ISLAND DR | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784124913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617611000 | ||||||||
| FaxNumber: | 3618575960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NICOSIA | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3618781101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.