Provider Demographics
NPI:1346593654
Name:SOUTH COAST FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:SOUTH COAST FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-452-9320
Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-452-9320
Mailing Address - Fax:361-857-0572
Practice Address - Street 1:6182 DUNBARTON OAK ST STE B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4276
Practice Address - Country:US
Practice Address - Phone:361-452-9320
Practice Address - Fax:361-452-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX272184OtherMEDICARE