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CORRIDOR PRIMARY CARE PA NPI 1124050836


NPI Information

NPI: 1124050836
Provider Name: CORRIDOR PRIMARY CARE, PA
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 45D0504327

Address:
1320 WONDER WORLD DR STE 101
SAN MARCOS, TX
ZIP 78666
Phone: (512) 392-1700
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CORRIDOR PRIMARY CARE, PA is a pediatrics in San Marcos, TX. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. CORRIDOR PRIMARY CARE, PA NPI is 1124050836. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1320 WONDER WORLD DR STE 101
SAN MARCOS, TX
ZIP 78666-558
Phone: (512) 392-1700
Fax: (512) 396-8743

The provider's authorized official is Michelle M Bludworth .
The authorized official title is Office Manager and has the following contact phone number (512) 392-1700.

The CLIA number assigned to this NPI record is 45D0504327 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/6/2006 and was last updated on 12/10/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineNo
2208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100T63UMEDICARE UPINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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