Provider Demographics
NPI:1285864058
Name:COASTALSURG, INC
Entity Type:Organization
Organization Name:COASTALSURG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-607-6516
Mailing Address - Street 1:4466 DOWNING PLACE WAY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8068
Mailing Address - Country:US
Mailing Address - Phone:843-607-6515
Mailing Address - Fax:843-884-4723
Practice Address - Street 1:4466 DOWNING PLACE WAY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8068
Practice Address - Country:US
Practice Address - Phone:843-607-6515
Practice Address - Fax:843-884-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies