MEDICARE: COASTAL FOOT & ANKLE CENTER LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1881527109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL FOOT & ANKLE CENTER LLC

Provider Business Mailing Address
First Line	:	1050 FORDING ISLAND RD STE C
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-8667
Country	:	US
Telephone Number	:	910-382-8480
Fax Number	:

Provider Business Practice Location Address
First Line	:	69 TOWNE DR
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4201
Country	:	US
Telephone Number	:	910-382-8480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN THORNBERRY
Credential	:	DPM
Telephone Number	:	910-382-8480

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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