Healthcare Provider Details

I. General information

NPI: 1508384652
Provider Name (Legal Business Name): JCM VEIN PLLC VEIN CARE COASTAL BEND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 S ALAMEDA ST STE 402
CORPUS CHRISTI TX
78411-1882
US

IV. Provider business mailing address

PO BOX 61160
CORPUS CHRISTI TX
78466-1160
US

V. Phone/Fax

Practice location:
  • Phone: 361-371-8100
  • Fax: 361-371-8101
Mailing address:
  • Phone: 361-884-2904
  • Fax: 361-884-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES RODMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 361-884-2904