Provider Demographics
NPI:1760490361
Name:CORPUS CHRISTI GASTROENTEROLOGY PLLC
Entity type:Organization
Organization Name:CORPUS CHRISTI GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-991-7109
Mailing Address - Street 1:6421 SARATOGA BLVD.
Mailing Address - Street 2:BLDG. 106
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3480
Mailing Address - Country:US
Mailing Address - Phone:361-991-7109
Mailing Address - Fax:361-991-5213
Practice Address - Street 1:6421 SARATOGA BLVD.
Practice Address - Street 2:BLDG. 106
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3480
Practice Address - Country:US
Practice Address - Phone:361-991-7109
Practice Address - Fax:361-991-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCI2751OtherRAILROAD MEDICARE
TX080318101Medicaid
TX00294KMedicare PIN