Healthcare Provider Details

I. General information

NPI: 1336713890
Provider Name (Legal Business Name): COASTAL SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 SHATTUCK WAY
NEWINGTON NH
03801
US

IV. Provider business mailing address

155 BORTHWICK AVENUE SUITE 200 E
PORTSMOUTH NH
03801
US

V. Phone/Fax

Practice location:
  • Phone: 561-330-3381
  • Fax: 561-330-3382
Mailing address:
  • Phone: 561-330-3381
  • Fax: 561-330-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. N. TIMOTHY PETERS
Title or Position: MEDICAL DIRECTOR, MEMBER
Credential: MD
Phone: 603-969-9297