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NPI Code Detail

MEDICARE: COASTAL NEUROLOGIC INSTITUTE

MEDICARE: COASTAL NEUROLOGIC INSTITUTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantAL

General Provider Information

NPI Number : 1508303280
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL NEUROLOGIC INSTITUTE
Provider Business Mailing Address
First Line : 30762 STATE HIGHWAY 181
Second Line :
City : SPANISH FORT
State : AL
Zip : 36527-5672
Country : US
Telephone Number : 205-382-0908
Fax Number :
Provider Business Practice Location Address
First Line : 30762 STATE HIGHWAY 181
Second Line :
City : SPANISH FORT
State : AL
Zip : 36527-5672
Country : US
Telephone Number : 205-382-0908
Fax Number :
Authorized Official
Title or Position : PHYSICIAN ASSISTANT
Name : MS. SIDNEY LYNN MCCLENDON
Credential : PA-C
Telephone Number : 205-382-0908
Provider Enumeration Date : 01/19/2017
Last Update Date : 01/19/2017

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Directions to “COASTAL NEUROLOGIC INSTITUTE ” Practice Location

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