Provider Demographics
NPI:1275735441
Name:COASTAL CAROLINA PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:COASTAL CAROLINA PHYSICIAN PRACTICES LLC
Other - Org Name:COASTAL CAROLINA NEUROLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-3446
Mailing Address - Country:US
Mailing Address - Phone:843-681-4433
Mailing Address - Fax:843-836-3677
Practice Address - Street 1:8 HOSPITAL CENTER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-8700
Practice Address - Country:US
Practice Address - Phone:843-681-4433
Practice Address - Fax:843-836-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8640Medicare ID - Type Unspecified