Organization
ROCKPORT MEDICAL CLINIC LLC
Active
Other names
Coastal Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY D. BINGHAM P.A. (OWNER PROVIDER)
(361) 790-9047
Entity
Organization
Contact information
Practice address
1704 JENKINS ST, ROCKPORT, TX 78382-3341
(361) 790-9047
(361) 790-9615
Mailing address
1704 JENKINS ST, ROCKPORT, TX 78382-3341
(361) 790-9047
(361) 790-9615
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
TX
261QR1300X
Rural Health Clinic/Center
Primary
673904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0082RB
BLUE CROSS
TX
05
—
196052801
—
TX
01
—
196052802
MEDICAID # FOR RURAL HEALTH CLINIC
TX
Enumeration date
01/04/2008
Last updated
12/06/2022
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