| Coastal Family Medicine, Llc | |
|
230 Parking Way St Lake Jackson TX 77566-5227 | |
| (979) 487-2135 | |
| (979) 341-0814 |
| Full Name | Coastal Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 230 Parking Way St, Lake Jackson, Texas |
| Authorized Official Name and Position | Samantha Gonzalez (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 9794872135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Family Medicine, Llc 52 Willow Ct Lake Jackson TX 77566-4718 Ph: (979) 824-8007 | Coastal Family Medicine, Llc 230 Parking Way St Lake Jackson TX 77566-5227 Ph: (979) 487-2135 |
| NPI Number | 1831671445 |
|---|---|
| Provider Enumeration Date | 08/30/2018 |
| Last Update Date | 01/03/2019 |
| Medicare PECOS PAC ID | 2860745197 |
|---|---|
| Medicare Enrollment ID | O20181102000447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831671445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Wasim M Khan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1992717201 PECOS PAC ID: 3476621012 Enrollment ID: I20081008000826 |
| Provider Name | Kaitlin Dingee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194266288 PECOS PAC ID: 1355608910 Enrollment ID: I20171206003145 |
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