Healthcare Provider Details

I. General information

NPI: 1740830959
Provider Name (Legal Business Name): COASTAL PLAINS ENDEAVORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 E HOUSTON ST STE A
BEEVILLE TX
78102-5335
US

IV. Provider business mailing address

1602 E HOUSTON ST STE A
BEEVILLE TX
78102-5335
US

V. Phone/Fax

Practice location:
  • Phone: 210-111-1111
  • Fax:
Mailing address:
  • Phone: 361-358-9200
  • Fax: 361-354-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES SCHLOTTER
Title or Position: MD
Credential: MD
Phone: 361-358-9200