Healthcare Provider Details

I. General information

NPI: 1144760927
Provider Name (Legal Business Name): COASTAL HOUSE CALLS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 JAMESTOWN DR SUITE 203
MURRELLS INLET SC
29576-7507
US

IV. Provider business mailing address

671 JAMESTOWN DR SUITE 203
MURRELLS INLET SC
29576-7507
US

V. Phone/Fax

Practice location:
  • Phone: 843-631-4656
  • Fax:
Mailing address:
  • Phone: 843-631-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. JORDAN RICHMOND
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 843-631-4656