Provider Demographics
NPI:1083893572
Name:COASTAL SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:COASTAL SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-841-4909
Mailing Address - Street 1:16787 BEACH BLVD
Mailing Address - Street 2:SUITE 615
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4848
Mailing Address - Country:US
Mailing Address - Phone:714-843-9338
Mailing Address - Fax:714-843-6404
Practice Address - Street 1:17672 BEACH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6836
Practice Address - Country:US
Practice Address - Phone:714-841-4909
Practice Address - Fax:714-847-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical