| Coastal Bend Family Medicine, P.a. | |
|
4818 Holly Rd Suite A Corpus Christi TX 78411-4734 | |
| (361) 993-1747 | |
| (361) 993-1748 |
| Full Name | Coastal Bend Family Medicine, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 4818 Holly Rd, Corpus Christi, Texas |
| Authorized Official Name and Position | David Loyd Vanderheiden (PRESIDENT) |
| Authorized Official Contact | 3619931747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Bend Family Medicine, P.a. 4818 Holly Rd Suite A Corpus Christi TX 78411-4734 Ph: (361) 993-1747 | Coastal Bend Family Medicine, P.a. 4818 Holly Rd Suite A Corpus Christi TX 78411-4734 Ph: (361) 993-1747 |
| NPI Number | 1629062179 |
|---|---|
| Provider Enumeration Date | 09/09/2005 |
| Last Update Date | 03/08/2017 |
| Medicare PECOS PAC ID | 0345239927 |
|---|---|
| Medicare Enrollment ID | O20040510000181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629062179 | NPI | - | NPPES |
| 109485601 | Medicaid | TX | |
| 00K51Q | Other | TX | MEDICARE |
| 00K51Q | Other | TX | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H8480 (Texas) | Primary |
| Provider Name | David Vanderheiden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790779247 PECOS PAC ID: 5698764280 Enrollment ID: I20040510000275 |
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