Provider Demographics
NPI:1144910423
Name:COASTAL SURGICAL SERVICES LLC
Entity type:Organization
Organization Name:COASTAL SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:321-626-9794
Mailing Address - Street 1:48 FORT ROYAL IS
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6014
Mailing Address - Country:US
Mailing Address - Phone:321-626-9794
Mailing Address - Fax:
Practice Address - Street 1:48 FORT ROYAL IS
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6014
Practice Address - Country:US
Practice Address - Phone:321-626-9794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty