Provider Demographics
NPI:1740458876
Name:KIMBERLY WILLS COATES M.D.
Entity type:Organization
Organization Name:KIMBERLY WILLS COATES M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-326-4300
Mailing Address - Street 1:511 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4007
Mailing Address - Country:US
Mailing Address - Phone:512-255-0769
Mailing Address - Fax:
Practice Address - Street 1:511 OAKWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4007
Practice Address - Country:US
Practice Address - Phone:512-255-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ1937OtherSTATE LICENSE NUMBER
TX0064LPOtherBCBS INDIVIDUAL
TXJ1937OtherSTATE LICENSE NUMBER
TX00924WMedicare PIN
TX8C0284Medicare PIN