Healthcare Provider Details

I. General information

NPI: 1487631115
Provider Name (Legal Business Name): UNITED STATES COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TANNER WILLIAMS RD
MOBILE AL
36608-8322
US

IV. Provider business mailing address

8501 TANNER WILLIAMS RD
MOBILE AL
36608-8322
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6561
  • Fax: 251-441-6415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. JOHN ALLEN
Title or Position: LIEUTENANT
Credential:
Phone: 251-441-6411