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General NPI Number Information
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NPI Number | 1053762740
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Entity Type | Organization
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Legal Business Name | COASTAL HEALTHCARE PARTNERS, LLC
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 50 LEANNI WAY SUITE D1
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-283-5997
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Fax | 386-283-5652
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Provider Business Mailing Address
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Address Line | 50 LEANNI WAY SUITE D1
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-283-5997
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Fax | 386-283-5652
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ALLEN OSBORNE
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Credential | DC
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Telephone | 386-283-5997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME101968
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License Number State | FL
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