Provider Demographics
NPI:1710071543
Name:COASTAL BEND SURGERY CENTER, LTD.
Entity Type:Organization
Organization Name:COASTAL BEND SURGERY CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-993-2000
Mailing Address - Street 1:6130 PARKWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4121
Mailing Address - Country:US
Mailing Address - Phone:361-993-2000
Mailing Address - Fax:361-985-6834
Practice Address - Street 1:5837 SPOHN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4121
Practice Address - Country:US
Practice Address - Phone:361-993-2000
Practice Address - Fax:361-985-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008062261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00125360OtherPALMETTO RR MEDICARE PROV
TX085857301Medicaid
TXHH1243OtherBCBS PROVIDER NUMBER
TXP00125360OtherPALMETTO RR MEDICARE PROV