Provider Demographics
NPI:1013026939
Name:COASTAL BEND PET SCAN LTD
Entity Type:Organization
Organization Name:COASTAL BEND PET SCAN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:ERTZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-853-4503
Mailing Address - Street 1:3226 REID DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2552
Mailing Address - Country:US
Mailing Address - Phone:361-853-4503
Mailing Address - Fax:361-853-4454
Practice Address - Street 1:1533 5TH ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1901
Practice Address - Country:US
Practice Address - Phone:361-880-7226
Practice Address - Fax:361-881-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty