MEDICARE: COASTAL GATEWAY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033832167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL GATEWAY HEALTH CENTER

Provider Business Mailing Address
First Line	:	2584 STATE HIGHWAY 124
Second Line	:
City	:	WINNIE
State	:	TX
Zip	:	77665-7889
Country	:	US
Telephone Number	:	409-296-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2584 STATE HIGHWAY 124
Second Line	:
City	:	WINNIE
State	:	TX
Zip	:	77665-7889
Country	:	US
Telephone Number	:	409-296-4444
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KALEY SMITH
Credential	:
Telephone Number	:	409-496-4444

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	01/24/2024

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Directions to “COASTAL GATEWAY HEALTH CENTER ” Practice Location

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