Provider Demographics
NPI:1376582965
Name:COASTAL CAROLINA HEALTH CARE PA
Entity Type:Organization
Organization Name:COASTAL CAROLINA HEALTH CARE PA
Other - Org Name:CCHC SLEEP LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCKOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-514-6685
Mailing Address - Street 1:1020 MEDICAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5248
Mailing Address - Country:US
Mailing Address - Phone:252-634-2240
Mailing Address - Fax:252-634-2241
Practice Address - Street 1:1020 MEDICAL PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-0000
Practice Address - Country:US
Practice Address - Phone:252-634-2240
Practice Address - Fax:252-634-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016M2OtherBCBS OF NC
NC89016M2Medicaid
NC2323301DMedicare PIN
NC016M2OtherBCBS OF NC