Healthcare Provider Details

I. General information

NPI: 1295713774
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT (CG-1122) US COAST GUARD 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593
US

IV. Provider business mailing address

COMDT (CG-1122) US COAST GUARD 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6560
  • Fax:
Mailing address:
  • Phone: 251-441-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEREMIAH T. MCCARY
Title or Position: TECHNICIAN
Credential:
Phone: 251-441-6508