1437459732 NPI number — COASTAL FOOT CENTER LLC

Table of content: MEGAN NINA GORZKOWSKI LSW (NPI 1316745185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437459732 NPI number — COASTAL FOOT CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL FOOT CENTER LLC
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:
1437459732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9912 DIMITRIOS BLVD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAPHNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36526-9569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-626-6550
Provider Business Mailing Address Fax Number:
833-254-2641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9912 DIMITRIOS AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-9569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-626-6550
Provider Business Practice Location Address Fax Number:
833-254-2641
Provider Enumeration Date:
11/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
JOE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/PODIATRIST
Authorized Official Telephone Number:
251-626-6550

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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