Provider Demographics
NPI:1689695959
Name:COASTAL BEND AMBULATORY SURGICAL CENTER INC.
Entity Type:Organization
Organization Name:COASTAL BEND AMBULATORY SURGICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-888-4288
Mailing Address - Street 1:PO BOX 3827
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3827
Mailing Address - Country:US
Mailing Address - Phone:361-888-4288
Mailing Address - Fax:361-888-4786
Practice Address - Street 1:900 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2028
Practice Address - Country:US
Practice Address - Phone:361-888-4288
Practice Address - Fax:361-888-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000147261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNHH1251OtherBLUE CROSS/BLUE SHIELD
TX085872201Medicaid
TX490000435OtherMEDICARE- RAILROAD