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General NPI Number Information
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NPI Number | 1922109701
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPEDIC ASSOCIATES, PA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 2376 CYPRESS CIRCLE SUITE 300
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City | CONWAY
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State | SC
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Zip | 29526-8920
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Country | US
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Telephone | 843-347-7222
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Fax | 843-347-3305
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Provider Business Mailing Address
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Address Line | 2376 CYPRESS CIRCLE SUITE 300
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City | CONWAY
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State | SC
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Zip | 29526-8920
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Country | US
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Telephone | 843-347-7222
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Fax | 843-347-3305
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MRS. WENDY L MEARES
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Credential |
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Telephone | 843-234-7857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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