Provider Demographics
NPI:1538345681
Name:COASTAL SURGERY, PC
Entity type:Organization
Organization Name:COASTAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-970-1948
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:1668 NORTH PINE STREET
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-2065
Mailing Address - Country:US
Mailing Address - Phone:251-970-1948
Mailing Address - Fax:251-970-1593
Practice Address - Street 1:1668 N PINE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2220
Practice Address - Country:US
Practice Address - Phone:251-970-1948
Practice Address - Fax:251-970-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026690Medicaid
AL000099973Medicaid
1730153271OtherNPI
AL51026690OtherBCBS AL
AL1306842570OtherNPI
AL51002338OtherBCBS AL
AL51099973OtherBCBS AL
AL1275506917OtherNPI
AL529925730Medicaid
AL1306842570OtherNPI
AL529925730Medicaid
AL000026690Medicaid