MEDICARE: COASTAL BEND KIDS CLINIC PA

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1730163684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL BEND KIDS CLINIC PA

Provider Business Mailing Address
First Line	:	1018 S 14TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-6422
Country	:	US
Telephone Number	:	361-592-0223
Fax Number	:	361-592-0883

Provider Business Practice Location Address
First Line	:	1018 S 14TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-6422
Country	:	US
Telephone Number	:	361-592-0223
Fax Number	:	361-592-0883

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANIL C PATEL
Credential	:	MD
Telephone Number	:	361-592-0223

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	08/22/2020

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