Healthcare Provider Details

I. General information

NPI: 1144254517
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FERRY ROAD
GALVESTON TX
77553
US

IV. Provider business mailing address

1 FERRY ROAD
GALVESTON TX
77553
US

V. Phone/Fax

Practice location:
  • Phone: 409-766-4752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DEXTER HALL
Title or Position: HEALTH SERVICES TECH
Credential:
Phone: 409-766-4752