MEDICARE: SOUTH COAST FAMILY MEDICINE PLLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	272184	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1346593654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST FAMILY MEDICINE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 61160
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78466-1160
Country	:	US
Telephone Number	:	361-452-9320
Fax Number	:	361-857-0572

Provider Business Practice Location Address
First Line	:	6182 DUNBARTON OAK ST STE B
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4276
Country	:	US
Telephone Number	:	361-452-9320
Fax Number	:	361-452-9321

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT E CARO
Credential	:	MD
Telephone Number	:	361-452-9320

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	12/11/2019

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Directions to “SOUTH COAST FAMILY MEDICINE PLLC ” Practice Location

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