MEDICARE: COASTAL FAMILY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		MS

General Provider Information

NPI Number	:	1578578290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL FAMILY HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 475
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39533
Country	:	US
Telephone Number	:	228-818-2766
Fax Number	:	228-818-2394

Provider Business Practice Location Address
First Line	:	COASTAL FAMILY HEALTH CENTER
Second Line	:	5052 STE A
City	:	LONG BEACH
State	:	MS
Zip	:	39560
Country	:	US
Telephone Number	:	228-864-4818
Fax Number	:	228-864-4875

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOE M DAWSEY
Credential	:
Telephone Number	:	228-818-2766

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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Directions to “COASTAL FAMILY HEALTH CENTER ” Practice Location

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