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General NPI Number Information
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NPI Number | 1609697242
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Entity Type | Organization
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Legal Business Name | COASTAL ER XII, LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 9422 SPRING GREEN BLVD
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City | KATY
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State | TX
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Zip | 77494-3810
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Country | US
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Telephone | 346-615-0919
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Fax | 346-615-0920
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Provider Business Mailing Address
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Address Line | 4141 S STAPLES ST STE 101
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-2115
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Country | US
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Telephone | 361-851-6626
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Fax | 361-854-7204
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. HALEY LORIN RILEY
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Credential |
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Telephone | 361-851-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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