Basic Information
| Provider Information | |||||||||
| NPI: | 1427509264 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COASTAL BEND URGENT CARE, LLC | ||||||||
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| OtherOrganizationName: | BEEVILLE MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 S HILLSIDE DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | BEEVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781025324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138936214 | ||||||||
| FaxNumber: | 7186402713 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 S HILLSIDE DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | BEEVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781025324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615424076 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2016 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLYNN | ||||||||
| AuthorizedOfficialFirstName: | MERCEDITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7138936214 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP118292 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.