Provider Demographics
NPI:1043299415
Name:COASTAL BEND CANCER CENTER, PA
Entity Type:Organization
Organization Name:COASTAL BEND CANCER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-887-0067
Mailing Address - Street 1:PO BOX 81346
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1346
Mailing Address - Country:US
Mailing Address - Phone:361-887-0067
Mailing Address - Fax:361-887-1885
Practice Address - Street 1:1625 RODD FIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4926
Practice Address - Country:US
Practice Address - Phone:361-887-0067
Practice Address - Fax:361-887-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3846174400000X
TXK1120174400000X
TXL5449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151269101Medicaid
TX00465TOtherBLUE CROSS BLUE SHIELD
TX00465TOtherBLUE CROSS BLUE SHIELD
TXDA7222Medicare PIN