Provider Demographics
NPI:1770939696
Name:COASTAL BEND ORTHOPAEDIC SPECIALISTS, PLLC
Entity type:Organization
Organization Name:COASTAL BEND ORTHOPAEDIC SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:INDRESANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-202-0179
Mailing Address - Street 1:49 W BAR LE DOC DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6250
Mailing Address - Country:US
Mailing Address - Phone:612-202-0179
Mailing Address - Fax:
Practice Address - Street 1:49 W BAR LE DOC DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6250
Practice Address - Country:US
Practice Address - Phone:612-202-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8995207XS0106X
TXQ0940207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty