Coastal ER XII, LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

Legal business name

COASTAL ER XII, LLC

Practice address

9422 Spring Green Blvd
Katy, TX 77494-3810

Phone

(346) 615-0919

Fax

(346) 615-0920

NPI assigned

Oct 17, 2024

Organization subpart

No

Name

Mrs. Haley Lorin Riley

Title

Credentialing Manager

Phone

(361) 851-6626

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 17, 2024.

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1609697242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 S STAPLES ST STE 101",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784112115",
            "telephone_number": "361-851-6626",
            "fax_number": "361-854-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9422 SPRING GREEN BLVD",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774943810",
            "telephone_number": "346-615-0919",
            "fax_number": "346-615-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL ER XII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "HALEY",
        "authorized_official_middle_name": "LORIN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "361-851-6626",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emergency Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.