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Organization
COASTAL ER IV LLC
Active
Organization
COASTAL ER IV LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KENYON MD (DIRECTOR)
(361) 994-1911
Entity
Organization
Contact information
Practice address
7750 SOUTH PADRE ISLAND DRIVE, CORPUS CHRISTI, TX 78412
(361) 994-1911
Mailing address
7750 SOUTH PADRE ISLAND DRIVE, CORPUS CHRISTI, TX 78412
(361) 994-1911
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
H8172
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H8172
MEDICAL LICENSE
TX
Enumeration date
03/01/2016
Last updated
01/11/2024
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