Provider Demographics
NPI:1124669262
Name:COASTAL ER IX, LLC
Entity type:Organization
Organization Name:COASTAL ER IX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-851-6626
Mailing Address - Street 1:4141 S STAPLES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2115
Mailing Address - Country:US
Mailing Address - Phone:361-851-6626
Mailing Address - Fax:832-653-2978
Practice Address - Street 1:580 CIBOLO VALLEY DR STE 137
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3834
Practice Address - Country:US
Practice Address - Phone:210-251-3545
Practice Address - Fax:832-653-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care