Organization
COASTAL ER XII, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HALEY LORIN RILEY (CREDENTIALING MANAGER)
(361) 851-6626
Entity
Organization
Contact information
Practice address
9422 SPRING GREEN BLVD, KATY, TX 77494-3810
(346) 615-0919
(346) 615-0920
Mailing address
4141 S STAPLES ST STE 101, CORPUS CHRISTI, TX 78411-2115
(361) 851-6626
(361) 854-7204
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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