MEDICARE: COASTAL BEND URGENT CARE, LLC

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	363LF0000X	Family Nurse Practitioner	AP118292	TX
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1427509264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL BEND URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	301 S HILLSIDE DR STE 4
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5324
Country	:	US
Telephone Number	:	713-893-6214
Fax Number	:	718-640-2713

Provider Business Practice Location Address
First Line	:	301 S HILLSIDE DR STE 4
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5324
Country	:	US
Telephone Number	:	361-542-4076
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MERCEDITA FLYNN
Credential	:
Telephone Number	:	713-893-6214

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	08/15/2019

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