Healthcare Provider Details

I. General information

NPI: 1710071543
Provider Name (Legal Business Name): COASTAL BEND SURGERY CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 SPOHN DR
CORPUS CHRISTI TX
78413-4121
US

IV. Provider business mailing address

6130 PARKWAY DRIVE
CORPUS CHRISTI TX
78414-4121
US

V. Phone/Fax

Practice location:
  • Phone: 361-993-2000
  • Fax: 361-985-6834
Mailing address:
  • Phone: 361-993-2000
  • Fax: 361-985-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008062
License Number StateTX

VIII. Authorized Official

Name: MRS. NICOLE MORALES
Title or Position: CFO
Credential:
Phone: 361-993-2000