1922254457 NPI number — COASTAL ACCESS INC

Table of content: (NPI 1922254457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922254457 NPI number — COASTAL ACCESS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL ACCESS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922254457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3011 HIGHWAY 30 W # 101-166
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77340-3534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-581-5356
Provider Business Mailing Address Fax Number:
866-249-9163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3011 HIGHWAY 30 W # 101-166
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77340-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-581-5356
Provider Business Practice Location Address Fax Number:
866-249-9163
Provider Enumeration Date:
08/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUEVARA
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
936-661-9227

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 176786155 . This is a "DUNS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 332B00000X . This is a "MEMBER TAXONOMY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2248 . This is a "TRCC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: BNTCS0189 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: S500292970 . This is a "UNKNOWN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171WH0202X . This is a "MEMBER TAXONOMY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".