Healthcare Provider Details

I. General information

NPI: 1326120759
Provider Name (Legal Business Name): COASTAL WELLNESS INFUSION CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 BOWMAN GRAY DR STE A
GREENVILLE NC
27834-7286
US

IV. Provider business mailing address

503 BOWMAN GRAY DR STE A
GREENVILLE NC
27834-7286
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-2728
  • Fax: 252-752-8288
Mailing address:
  • Phone: 252-830-2728
  • Fax: 252-752-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD L RUMLEY
Title or Position: OWNER
Credential: MD
Phone: 252-830-2728