Healthcare Provider Details

I. General information

NPI: 1083843056
Provider Name (Legal Business Name): COASTAL BEND SURGICAL ASSISTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19406 CREEK BEND DR
SPRING TX
77388-3095
US

IV. Provider business mailing address

19406 CREEK BEND DR
SPRING TX
77388-3095
US

V. Phone/Fax

Practice location:
  • Phone: 936-718-9501
  • Fax: 281-719-0027
Mailing address:
  • Phone: 936-718-9501
  • Fax: 281-719-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00005
License Number StateTX

VIII. Authorized Official

Name: MR. NATHANAEL MCGREW
Title or Position: PRESIDENT
Credential: LSA, CFA
Phone: 936-718-9501