Healthcare Provider Details

I. General information

NPI: 1366984148
Provider Name (Legal Business Name): COASTAL ANESTHESIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HICKORY LN
HILTON HEAD ISLAND SC
29928-6239
US

IV. Provider business mailing address

8 HICKORY LN
HILTON HEAD ISLAND SC
29928-6239
US

V. Phone/Fax

Practice location:
  • Phone: 843-422-5340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHERIE DELLINGER
Title or Position: OWNER
Credential:
Phone: 843-422-5340