| Advanced Lymphedema Specialists | |
|
1521 S Staples St Ste 401 Corpus Christi TX 78404-3152 | |
| (361) 333-5472 | |
| Not Available |
| Full Name | Advanced Lymphedema Specialists |
|---|---|
| Speciality | Clinic/Center |
| Location | 1521 S Staples St Ste 401, Corpus Christi, Texas |
| Authorized Official Name and Position | Amanda Rios (CREDENTIALING/BILLING) |
| Authorized Official Contact | 7132129098 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Lymphedema Specialists 2657 Greenville Dr League City TX 77573-6401 Ph: (713) 212-9098 | Advanced Lymphedema Specialists 1521 S Staples St Ste 401 Corpus Christi TX 78404-3152 Ph: (361) 333-5472 |
| NPI Number | 1437874591 |
|---|---|
| Provider Enumeration Date | 10/11/2022 |
| Last Update Date | 12/05/2022 |
| Medicare PECOS PAC ID | 8527436609 |
|---|---|
| Medicare Enrollment ID | O20221121002132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437874591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Roberto Fabricio Diaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851300891 PECOS PAC ID: 4082602685 Enrollment ID: I20050124000218 |
| Provider Name | Kelli M Hubert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124383245 PECOS PAC ID: 0143479683 Enrollment ID: I20120927000427 |
| Provider Name | Santa Margarita Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649713694 PECOS PAC ID: 4183895840 Enrollment ID: I20161215000679 |
| Provider Name | Alyssa Lee Moffitt |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144763715 PECOS PAC ID: 5092187955 Enrollment ID: I20230202002611 |
| Provider Name | Joanna Emily Reed |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1215576970 PECOS PAC ID: 9234595422 Enrollment ID: I20230512001701 |
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