MEDICARE: COASTAL PLAINS ENDEAVORS 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	2086S0129X	Vascular Surgery Physician
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1740830959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL PLAINS ENDEAVORS LLC

Provider Business Mailing Address
First Line	:	1602 E HOUSTON ST STE A
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5335
Country	:	US
Telephone Number	:	361-358-9200
Fax Number	:	361-354-5714

Provider Business Practice Location Address
First Line	:	1602 E HOUSTON ST STE A
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5335
Country	:	US
Telephone Number	:	210-111-1111
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	JAMES SCHLOTTER
Credential	:	MD
Telephone Number	:	361-358-9200

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	11/21/2019

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Directions to “COASTAL PLAINS ENDEAVORS LLC ” Practice Location

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