MEDICARE: COASTAL HEALTH & WELLNESS

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1578088001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	14 CONFEDERATE DR S
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-3062
Country	:	US
Telephone Number	:	205-919-9279
Fax Number	:	208-947-3465

Provider Business Practice Location Address
First Line	:	14 CONFEDERATE DR S
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-3062
Country	:	US
Telephone Number	:	205-919-9279
Fax Number	:	208-947-3465

Authorized Official
Title or Position	:	OWNER
Name	:	BLAIR CARMICHAEL-LOBER
Credential	:	NP
Telephone Number	:	205-919-9279

Provider Enumeration Date	:	08/05/2017
Last Update Date	:	07/21/2022

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Directions to “COASTAL HEALTH & WELLNESS ” Practice Location

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