1134402712 NPI number — COASTAL PAIN SOLUTIONS, INC

Table of content: (NPI 1134402712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134402712 NPI number — COASTAL PAIN SOLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL PAIN SOLUTIONS, 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:
6
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:
1134402712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 REMITTANCE DR
Provider Second Line Business Mailing Address:
SUITE 6633
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60675-6633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-223-2115
Provider Business Mailing Address Fax Number:
772-223-0887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SE OCEAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34996-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-223-2115
Provider Business Practice Location Address Fax Number:
772-223-0887
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
MARC
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-337-7676

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002V3 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com