Healthcare Provider Details

I. General information

NPI: 1578824173
Provider Name (Legal Business Name): COASTAL ANESTHESIA-SOUTH BALDWIN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 N MCKENZIE ST ANESTHESIA DEPT
FOLEY AL
36535-2247
US

IV. Provider business mailing address

PO BOX 235019
MONTGOMERY AL
36123-5019
US

V. Phone/Fax

Practice location:
  • Phone: 251-949-3400
  • Fax:
Mailing address:
  • Phone: 800-232-5703
  • Fax: 334-395-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT C CALIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-949-3400