Provider Demographics
NPI:1487965166
Name:SOUTH TEXAS LIMB & WOUND CARE CENTER INC
Entity type:Organization
Organization Name:SOUTH TEXAS LIMB & WOUND CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-884-3984
Mailing Address - Street 1:3130 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2506
Mailing Address - Country:US
Mailing Address - Phone:361-884-3984
Mailing Address - Fax:361-884-3986
Practice Address - Street 1:3130 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2506
Practice Address - Country:US
Practice Address - Phone:361-884-3984
Practice Address - Fax:361-884-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1226213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty