Organization
COASTAL ER V, LLC
Active
Other names
Physicians PremiER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL KENYON MD (LLC BOARD MEMBER)
(361) 991-0811
Entity
Organization
Contact information
Practice address
11158 LEOPARD ST STE 103, CORPUS CHRISTI, TX 78410-2612
(361) 991-0811
Mailing address
PO BOX 6040, CORPUS CHRISTI, TX 78466-6040
(361) 884-2904
(361) 884-1912
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
160281
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160281
TDSHS FEC LICENSE
TX
Enumeration date
09/01/2016
Last updated
01/11/2024
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