Provider Demographics
NPI:1144760927
Name:COASTAL HOUSE CALLS, PC
Entity Type:Organization
Organization Name:COASTAL HOUSE CALLS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-631-4656
Mailing Address - Street 1:671 JAMESTOWN DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7507
Mailing Address - Country:US
Mailing Address - Phone:843-631-4656
Mailing Address - Fax:
Practice Address - Street 1:671 JAMESTOWN DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7507
Practice Address - Country:US
Practice Address - Phone:843-631-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty