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General NPI Number Information
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NPI Number | 1639223886
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Entity Type | Organization
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Legal Business Name | COASTAL FAMILY PRACTICE & ACUTE CARE CENTER LLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 9961 E COUNTY HIGHWAY 30A SUITE #5
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-7282
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Country | US
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Telephone | 850-231-9286
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Fax | 850-231-9287
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Provider Business Mailing Address
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Address Line | 9961 E COUNTY HIGHWAY 30A SUITE #5
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-7282
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Country | US
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Telephone | 850-231-9286
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Fax | 850-231-9287
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. WILLIAM ROBERT MARSHALL
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Credential |
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Telephone | 850-231-9286
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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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