Provider Demographics
NPI:1619143195
Name:LAKE CORPUS CHRISTI FAMILY MEDICAL
Entity Type:Organization
Organization Name:LAKE CORPUS CHRISTI FAMILY MEDICAL
Other - Org Name:COASTAL BEND HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-992-4500
Mailing Address - Street 1:4838 HOLLY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4753
Mailing Address - Country:US
Mailing Address - Phone:361-992-4500
Mailing Address - Fax:361-992-4502
Practice Address - Street 1:4838 HOLLY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4753
Practice Address - Country:US
Practice Address - Phone:361-992-4500
Practice Address - Fax:361-992-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4314173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty