Organization
COASTAL ER XI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HALEY LORIN RILEY (CREDENTIALING MANAGER)
(361) 851-6626
Entity
Organization
Contact information
Practice address
12314 POTRANCO RD STE 102, SAN ANTONIO, TX 78253-4125
(210) 981-3001
Mailing address
4141 S STAPLES ST STE 101, CORPUS CHRISTI, TX 78411-2115
(361) 851-6626
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2024
Last updated
01/10/2024
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