Healthcare Provider Details

I. General information

NPI: 1720148448
Provider Name (Legal Business Name): COASTAL ULTRASOUND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 B COURTHOUSE RD
GULFPORT MS
39507-1214
US

IV. Provider business mailing address

45 HARDY COURT, SHOPPING CTR #187
GULFPORT MS
39507-2501
US

V. Phone/Fax

Practice location:
  • Phone: 228-547-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number38162
License Number StateLA

VIII. Authorized Official

Name: HOLLY THOMAS ARNOULT
Title or Position: CO-OWNER OFFICE MANAGER
Credential:
Phone: 228-547-2250