Provider Demographics
NPI:1225253818
Name:COASTAL NEUROSURGERY AND SPINE
Entity Type:Organization
Organization Name:COASTAL NEUROSURGERY AND SPINE
Other - Org Name:COASTAL NEUROSURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FAILE
Authorized Official - Suffix:III
Authorized Official - Credentials:MHA
Authorized Official - Phone:843-723-8823
Mailing Address - Street 1:2145 HENRY TECKLENBURG DR
Mailing Address - Street 2:STE 220
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2145 HENRY TECKLENBURG DR
Practice Address - Street 2:STE 220
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5893
Practice Address - Country:US
Practice Address - Phone:843-723-8823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19481207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty