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General NPI Number Information
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NPI Number | 1184459661
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Entity Type | Organization
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Legal Business Name | COASTAL CONCIERGE HEALTH, PLLC
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 801 N HOWE ST STE 5
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City | SOUTHPORT
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State | NC
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Zip | 28461-3351
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Country | US
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Telephone | 910-622-0952
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Fax |
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Provider Business Mailing Address
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Address Line | 801 N HOWE ST STE 5
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City | SOUTHPORT
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State | NC
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Zip | 28461-3351
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Country | US
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Telephone | 910-477-6002
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Fax | 833-974-3842
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Authorized Official
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Title or Position | NP
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Name | MATTHEW LUCAS
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Credential | NP
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Telephone | 910-622-0952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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