Provider Demographics
NPI:1437768033
Name:COASTAL INJURY CLINIC LLC
Entity Type:Organization
Organization Name:COASTAL INJURY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHRISTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-685-7688
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-1869
Mailing Address - Country:US
Mailing Address - Phone:904-559-6638
Mailing Address - Fax:888-927-0401
Practice Address - Street 1:2700 RIVERSIDE AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8233
Practice Address - Country:US
Practice Address - Phone:904-559-6638
Practice Address - Fax:888-927-0401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS GROUP SERVICES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-29
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty