Provider Demographics
NPI:1861161044
Name:COASTAL COMPREHENSIVE CARE PA
Entity type:Organization
Organization Name:COASTAL COMPREHENSIVE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-663-2273
Mailing Address - Street 1:710 SUNSET BLVD N STE A
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-4340
Mailing Address - Country:US
Mailing Address - Phone:910-663-2273
Mailing Address - Fax:910-663-4050
Practice Address - Street 1:805 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4613
Practice Address - Country:US
Practice Address - Phone:910-663-2273
Practice Address - Fax:910-663-4050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL COMPREHENSIVE CARE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty