MEDICARE: COASTAL ER VIII, 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	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1801319983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL ER VIII, LLC

Provider Business Mailing Address
First Line	:	PO BOX 6844
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78466-6844
Country	:	US
Telephone Number	:	361-884-2904
Fax Number	:	512-852-4625

Provider Business Practice Location Address
First Line	:	20475 HIGHWAY 46 W STE 100
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6147
Country	:	US
Telephone Number	:	830-438-6911
Fax Number	:	512-852-4625

Authorized Official
Title or Position	:	LLC MEMBER
Name	:	DR. LONNIE SCHWIRTLICH
Credential	:	MD
Telephone Number	:	830-438-6911

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	07/20/2017

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