Healthcare Provider Details

I. General information

NPI: 1427046408
Provider Name (Legal Business Name): COASTAL FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15024 MARTIN LUTHER KING JR BLVD
GULFPORT MS
39501-8306
US

IV. Provider business mailing address

PO BOX 475
BILOXI MS
39533-0475
US

V. Phone/Fax

Practice location:
  • Phone: 228-863-9781
  • Fax: 229-374-0856
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-374-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE M DAWSEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 228-374-2494