Provider Demographics
NPI:1003892555
Name:ANTHONY MEDICAL ASSOCIATES P C
Entity Type:Organization
Organization Name:ANTHONY MEDICAL ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-447-8982
Mailing Address - Street 1:1330 N COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5526
Mailing Address - Country:US
Mailing Address - Phone:260-447-8982
Mailing Address - Fax:260-447-4483
Practice Address - Street 1:1330 N COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5526
Practice Address - Country:US
Practice Address - Phone:260-447-8982
Practice Address - Fax:260-447-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200401400AMedicaid
IN192580Medicare ID - Type Unspecified