Healthcare Provider Details

I. General information

NPI: 1922109701
Provider Name (Legal Business Name): COASTAL ORTHOPEDIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 CYPRESS CIRCLE SUITE 300
CONWAY SC
29526-8920
US

IV. Provider business mailing address

2376 CYPRESS CIRCLE SUITE 300
CONWAY SC
29526-8920
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-7222
  • Fax: 843-347-3305
Mailing address:
  • Phone: 843-347-7222
  • Fax: 843-347-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. WENDY L MEARES
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 843-234-7857