Basic Information
| Provider Information | |||||||||
| NPI: | 1417477092 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COASTAL BEND URGENT CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COASTAL BEND LONG TERM CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S HILLSIDE DR | ||||||||
| Address2: | |||||||||
| City: | BEEVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781025327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3613588880 | ||||||||
| FaxNumber: | 3613588153 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S HILLSIDE DR | ||||||||
| Address2: | |||||||||
| City: | BEEVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781025327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3613588880 | ||||||||
| FaxNumber: | 3613588153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GRAPPE | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | LOWE | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3613588880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COASTAL BEND URGENT CARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.