Provider Demographics
NPI:1376125302
Name:COASTAL CONCIERGE INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:COASTAL CONCIERGE INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-820-8580
Mailing Address - Street 1:1411 N FLAGLER DR STE 6700
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3417
Mailing Address - Country:US
Mailing Address - Phone:561-768-4018
Mailing Address - Fax:561-760-4583
Practice Address - Street 1:1411 N FLAGLER DR STE 6700
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3417
Practice Address - Country:US
Practice Address - Phone:561-768-4018
Practice Address - Fax:561-760-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty