Provider Demographics
NPI:1659491256
Name:COASTAL TEXAS CARDIOVASCULAR INC
Entity Type:Organization
Organization Name:COASTAL TEXAS CARDIOVASCULAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-397-7000
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0100
Mailing Address - Country:US
Mailing Address - Phone:713-850-1190
Mailing Address - Fax:
Practice Address - Street 1:800 PEAKWOOD DR
Practice Address - Street 2:4B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2900
Practice Address - Country:US
Practice Address - Phone:281-397-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00Y231Medicare PIN