Healthcare Provider Details

I. General information

NPI: 1427509264
Provider Name (Legal Business Name): COASTAL BEND URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S HILLSIDE DR STE 4
BEEVILLE TX
78102-5324
US

IV. Provider business mailing address

301 S HILLSIDE DR STE 4
BEEVILLE TX
78102-5324
US

V. Phone/Fax

Practice location:
  • Phone: 361-542-4076
  • Fax:
Mailing address:
  • Phone: 713-893-6214
  • Fax: 718-640-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP118292
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERCEDITA FLYNN
Title or Position: OWNER
Credential:
Phone: 713-893-6214