Provider Demographics
NPI:1902219348
Name:COASTAL ER I, LLC
Entity Type:Organization
Organization Name:COASTAL ER I, LLC
Other - Org Name:PHYSICIANS PREMIER EMERGENCY ROOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-980-0911
Mailing Address - Street 1:PO BOX 6040
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6040
Mailing Address - Country:US
Mailing Address - Phone:361-723-0226
Mailing Address - Fax:512-852-4625
Practice Address - Street 1:5521 SARATOGA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2843
Practice Address - Country:US
Practice Address - Phone:361-980-0911
Practice Address - Fax:361-980-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160125OtherTDSHS FSEC LICENSE