Healthcare Provider Details

I. General information

NPI: 1073421442
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ARKADELPHIA RD.
BIRMINGHAM AL
35204
US

IV. Provider business mailing address

900 ARKADELPHIA RD.
BIRMINGHAM AL
35204
US

V. Phone/Fax

Practice location:
  • Phone: 571-610-3432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1101X
TaxonomyMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM GAINEY
Title or Position: CLINIC BRANCH CHIEF
Credential:
Phone: 571-610-4032