Healthcare Provider Details

I. General information

NPI: 1033541156
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
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: 251-441-6560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA VINLOVE
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 251-441-6560