Provider Demographics
NPI:1104433531
Name:COASTAL BEND HOUSE CALLS
Entity type:Organization
Organization Name:COASTAL BEND HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:361-985-1221
Mailing Address - Street 1:4444 CORONA DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4322
Mailing Address - Country:US
Mailing Address - Phone:361-992-4500
Mailing Address - Fax:361-992-4502
Practice Address - Street 1:4444 CORONA DR STE 130
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4322
Practice Address - Country:US
Practice Address - Phone:361-992-4500
Practice Address - Fax:361-992-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty