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General NPI Number Information
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NPI Number | 1033107289
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Entity Type | Organization
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Legal Business Name | COASTAL FAMILY HEALTH CENTER INC
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 15024 MARTIN LUTHER KING JR BLVD
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City | GULFPORT
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State | MS
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Zip | 39501-8306
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Country | US
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Telephone | 228-864-0003
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Fax | 228-374-0856
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Provider Business Mailing Address
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Address Line | 10467 CORPORATE DR
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City | GULFPORT
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State | MS
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Zip | 39503-4634
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Country | US
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Telephone | 228-374-2494
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Fax | 228-396-3457
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Authorized Official
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Title or Position | CEO
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Name | ANGELIQUE S GREER
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Credential |
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Telephone | 228-374-2494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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