Healthcare Provider Details

I. General information

NPI: 1144315540
Provider Name (Legal Business Name): UNITED STATES COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUNRO AVE
CAPE MAY NJ
08204-5000
US

IV. Provider business mailing address

1 MUNRO AVE
CAPE MAY NJ
08204-5000
US

V. Phone/Fax

Practice location:
  • Phone: 609-898-6966
  • Fax: 609-898-6962
Mailing address:
  • Phone: 609-898-6966
  • Fax: 609-898-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number24720000X
License Number StateDC

VIII. Authorized Official

Name: MRS. MARIA INEZ DICKINSON
Title or Position: HEALTH SERVICES TECHNICAN
Credential:
Phone: 609-898-6966