=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013937226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL CANCER CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 MEDICAL CENTER DR
-----------------------------------------------------
City | SUPPLY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28462-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-755-7509
-----------------------------------------------------
Fax | 843-692-5015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8121 ROURK ST
-----------------------------------------------------
City | MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29572-4128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-692-5000
-----------------------------------------------------
Fax | 843-692-5015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EMILY TOULOUKIAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 843-692-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 200100151
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------