MEDICARE: COASTAL ANESTHESIA ASSOCIATES, 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	207L00000X	Anesthesiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ4348	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942252176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL ANESTHESIA ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1465
Second Line	:
City	:	LADSON
State	:	SC
Zip	:	29456-1465
Country	:	US
Telephone Number	:	843-553-7070
Fax Number	:	843-553-2223

Provider Business Practice Location Address
First Line	:	14 BROUGHTON RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7529
Country	:	US
Telephone Number	:	843-553-7070
Fax Number	:	843-553-2223

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDALL E KERNS
Credential	:	M.D.
Telephone Number	:	843-442-2486

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/20/2012

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Directions to “COASTAL ANESTHESIA ASSOCIATES, LLC ” Practice Location

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