Organization
AMED-COASTAL THERAPISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER F CROWDER (CEO)
(409) 935-1234
Entity
Organization
Contact information
Practice address
6501 MEMORIAL DR, TEXAS CITY, TX 77591-4015
(409) 935-1393
(409) 935-3844
Mailing address
8900 EMMETT F LOWRY EXPY, SUITE 104, TEXAS CITY, TX 77591-9116
(409) 935-7925
(409) 935-7926
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
520220000
TX
261QR0400X
Rehabilitation Clinic/Center
Primary
617670000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076AW
BLUE CROSS BLUE SHIELD
TX
05
—
021732501
—
TX
Enumeration date
12/28/2005
Last updated
02/13/2012
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