Organization
SOUTH PADRE ISLAND PEDIATRIC CLINIC PA
Active
Organization
SOUTH PADRE ISLAND PEDIATRIC CLINIC PA
Active
Other names
SOUTH PADRE ISLAND PEDIATRIC-MATHIS
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDY GONZALEZ (OFFICE MANAGER)
(361) 854-4626
Entity
Organization
Contact information
Practice address
220 E. ST. MARY'S STREET, MATHIS, TX 78368
(361) 758-1984
(361) 851-5193
Mailing address
220 E. ST. MARY'S STREET, MATHIS, TX 78368
(361) 547-5100
(361) 851-5193
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
E4618
TX
261QR1300X
Rural Health Clinic/Center
G6791
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127051405
—
TX
Enumeration date
11/24/2008
Last updated
10/31/2025
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