Healthcare Provider Details

I. General information

NPI: 1184459661
Provider Name (Legal Business Name): COASTAL CONCIERGE HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N HOWE ST STE 5
SOUTHPORT NC
28461-3351
US

IV. Provider business mailing address

801 N HOWE ST STE 5
SOUTHPORT NC
28461-3351
US

V. Phone/Fax

Practice location:
  • Phone: 910-622-0952
  • Fax:
Mailing address:
  • Phone: 910-477-6002
  • Fax: 833-974-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LUCAS
Title or Position: NP
Credential: NP
Phone: 910-622-0952