Healthcare Provider Details

I. General information

NPI: 1417988916
Provider Name (Legal Business Name): COASTAL FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 ORANGE GROVE ROAD
MOSS POINT MS
39563
US

IV. Provider business mailing address

PO BOX 475
BILOXI MS
39533
US

V. Phone/Fax

Practice location:
  • Phone: 228-473-9945
  • Fax: 228-475-3747
Mailing address:
  • Phone: 228-818-2766
  • Fax: 228-818-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOE M DAWSEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 228-818-2766