Provider Demographics
NPI:1275132094
Name:COASTAL CARDIOVASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:COASTAL CARDIOVASCULAR CENTER, LLC
Other - Org Name:COASTAL CARDIOVASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-7500
Mailing Address - Street 1:701 CEDAR LAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7815
Mailing Address - Country:US
Mailing Address - Phone:361-884-3278
Mailing Address - Fax:361-884-3279
Practice Address - Street 1:1025 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2041
Practice Address - Country:US
Practice Address - Phone:361-884-3278
Practice Address - Fax:361-884-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty