Provider Demographics
NPI:1588738389
Name:WOMEN'S & MEN'S HEALTH SERVICES OF THE COASTAL BEND, INC.
Entity type:Organization
Organization Name:WOMEN'S & MEN'S HEALTH SERVICES OF THE COASTAL BEND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STUKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-855-9107
Mailing Address - Street 1:3536 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-3214
Mailing Address - Country:US
Mailing Address - Phone:361-855-9107
Mailing Address - Fax:361-855-6822
Practice Address - Street 1:4410 DILLON LN
Practice Address - Street 2:SUITE 1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5330
Practice Address - Country:US
Practice Address - Phone:361-855-9107
Practice Address - Fax:361-855-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0883308-03OtherTPI