Basic Information
Provider Information | |||||||||
NPI: | 1801319983 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COASTAL ER VIII, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PHYSICIANS PREMIER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 6844 | ||||||||
Address2: |   | ||||||||
City: | CORPUS CHRISTI | ||||||||
State: | TX | ||||||||
PostalCode: | 784666844 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3618842904 | ||||||||
FaxNumber: | 5128524625 | ||||||||
Practice Location | |||||||||
Address1: | 20475 HIGHWAY 46 W STE 100 | ||||||||
Address2: |   | ||||||||
City: | SPRING BRANCH | ||||||||
State: | TX | ||||||||
PostalCode: | 780706147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8304386911 | ||||||||
FaxNumber: | 5128524625 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2017 | ||||||||
LastUpdateDate: | 07/20/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCHWIRTLICH | ||||||||
AuthorizedOfficialFirstName: | LONNIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | LLC MEMBER | ||||||||
AuthorizedOfficialTelephone: | 8304386911 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.