Organization
ROCKPORT MEDICAL CLINIC LLC
Active
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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