Provider Demographics
NPI:1043762578
Name:COASTAL ER VII, LLC
Entity Type:Organization
Organization Name:COASTAL ER VII, LLC
Other - Org Name:PHYSICIANS PREMIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-337-0911
Mailing Address - Street 1:PO BOX 6327
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6327
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:361-884-1912
Practice Address - Street 1:3154 SE MILITARY DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3975
Practice Address - Country:US
Practice Address - Phone:210-337-0911
Practice Address - Fax:361-884-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160288261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care