Provider Demographics
NPI:1508384652
Name:JCM VEIN PLLC VEIN CARE COASTAL BEND
Entity Type:Organization
Organization Name:JCM VEIN PLLC VEIN CARE COASTAL BEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-2904
Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:361-884-1912
Practice Address - Street 1:3301 S ALAMEDA ST STE 402
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1882
Practice Address - Country:US
Practice Address - Phone:361-371-8100
Practice Address - Fax:361-371-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty