Provider Demographics
NPI:1508882036
Name:SOUTH COAST HEALTH CARE OF TEXAS, PA
Entity Type:Organization
Organization Name:SOUTH COAST HEALTH CARE OF TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-572-0333
Mailing Address - Street 1:1908 N LAURENT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5469
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-572-8518
Practice Address - Street 1:2700 CITIZENS PLZ STE 100
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5756
Practice Address - Country:US
Practice Address - Phone:361-579-1371
Practice Address - Fax:361-579-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081AXOtherBLUE CROSS
TX081198601Medicaid
TX0081AXMedicare PIN