Healthcare Provider Details

I. General information

NPI: 1467635128
Provider Name (Legal Business Name): COASTAL HEALTHCARE RESOURCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W EVANS ST STE C
FLORENCE SC
29501-3374
US

IV. Provider business mailing address

PO BOX 6467
FLORENCE SC
29502-6467
US

V. Phone/Fax

Practice location:
  • Phone: 866-877-2762
  • Fax: 866-992-7144
Mailing address:
  • Phone: 866-877-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD C HAMRICK JR.
Title or Position: CEO
Credential: MD
Phone: 866-877-2762