Provider Demographics
NPI:1730159104
Name:ABDOMINAL SPECIALISTS OF SOUTH TEXAS, LLP
Entity type:Organization
Organization Name:ABDOMINAL SPECIALISTS OF SOUTH TEXAS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-884-2858
Mailing Address - Street 1:718 ELIZABETH ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2212
Mailing Address - Country:US
Mailing Address - Phone:361-884-2858
Mailing Address - Fax:361-879-9015
Practice Address - Street 1:718 ELIZABETH ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2212
Practice Address - Country:US
Practice Address - Phone:361-884-2858
Practice Address - Fax:361-879-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112280601Medicaid
TX112280601Medicaid