Provider Demographics
NPI:1003223389
Name:COASTAL MIDWIFERY
Entity Type:Organization
Organization Name:COASTAL MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:954-648-4990
Mailing Address - Street 1:10200 W STATE ROAD 84
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4204
Mailing Address - Country:US
Mailing Address - Phone:954-648-4990
Mailing Address - Fax:954-644-8931
Practice Address - Street 1:10200 W STATE ROAD 84
Practice Address - Street 2:SUITE 230
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4204
Practice Address - Country:US
Practice Address - Phone:954-648-4990
Practice Address - Fax:954-644-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW252176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004436500Medicaid