Healthcare Provider Details

I. General information

NPI: 1659950202
Provider Name (Legal Business Name): COASTAL FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 DAVIS AVE
PASS CHRISTIAN MS
39571-4541
US

IV. Provider business mailing address

10467 CORPORATE DR
GULFPORT MS
39503-4634
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-2494
  • Fax: 228-396-3457
Mailing address:
  • Phone: 228-374-2494
  • Fax:

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: ANGELIQUE GREER
Title or Position: CEO
Credential:
Phone: 228-374-2494