1538345681 NPI number — COASTAL SURGERY, PC

Table of content: (NPI 1538345681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538345681 NPI number — COASTAL SURGERY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL SURGERY, PC
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:
1538345681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2065
Provider Second Line Business Mailing Address:
1668 NORTH PINE STREET
Provider Business Mailing Address City Name:
FOLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36536-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-970-1948
Provider Business Mailing Address Fax Number:
251-970-1593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1668 N PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLEY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36535-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-970-1948
Provider Business Practice Location Address Fax Number:
251-970-1593
Provider Enumeration Date:
01/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHARLTON
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
DARLENE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
251-970-1948

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000026690 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000099973 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730153271 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51026690 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1306842570 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51002338 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51099973 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1275506917 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529925730 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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