Provider Demographics
NPI:1104010834
Name:COASTAL FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:COASTAL FAMILY HEALTH CENTER, INC
Other - Org Name:CFHC MENTAL HEALTH MOBILE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAWSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-374-2494
Mailing Address - Street 1:1046 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2935
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:228-374-2713
Practice Address - Street 1:1046 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2935
Practice Address - Country:US
Practice Address - Phone:228-374-2494
Practice Address - Fax:228-374-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC00895OtherMEDICARE/MS CAHABA
MS251971Medicare Oscar/Certification