Provider Demographics
NPI:1407952567
Name:COASTAL ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COASTAL ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-267-0058
Mailing Address - Street 1:PO BOX 30973
Mailing Address - Street 2:
Mailing Address - City:SEA ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31561-0973
Mailing Address - Country:US
Mailing Address - Phone:912-267-0058
Mailing Address - Fax:
Practice Address - Street 1:3217 4TH ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3759
Practice Address - Country:US
Practice Address - Phone:912-267-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2967Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
GA432CBTG02Medicare ID - Type Unspecified
GAR66491Medicare UPIN