Healthcare Provider Details

I. General information

NPI: 1164855227
Provider Name (Legal Business Name): COASTAL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 CHURCHILL RD
WALTERBORO SC
29488-3622
US

IV. Provider business mailing address

616 CHURCHILL RD
WALTERBORO SC
29488-3622
US

V. Phone/Fax

Practice location:
  • Phone: 843-693-6200
  • Fax: 513-858-7827
Mailing address:
  • Phone: 843-693-6200
  • Fax: 513-858-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number630
License Number StateSC

VIII. Authorized Official

Name: REBECCA SPITULSKI
Title or Position: OWNER
Credential:
Phone: 843-693-6200