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General NPI Number Information
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NPI Number | 1144619560
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Entity Type | Organization
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Legal Business Name | COAST URGENT CARE
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 179 REYNOIR ST
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City | BILOXI
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State | MS
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Zip | 39530-3831
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Country | US
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Telephone | 228-365-2363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7311
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City | DIBERVILLE
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State | MS
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Zip | 39540-7201
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Country | US
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Telephone | 228-365-2363
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MAYFIELD JENKINS
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Credential |
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Telephone | 228-365-2363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | MS
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