Provider Demographics
NPI:1467628867
Name:COASTAL URGENT CARE & FAMILY MEDICINE
Entity Type:Organization
Organization Name:COASTAL URGENT CARE & FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:CONGDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-467-1117
Mailing Address - Street 1:201 BUSINESS CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6522
Mailing Address - Country:US
Mailing Address - Phone:888-467-1117
Mailing Address - Fax:888-485-3336
Practice Address - Street 1:201 BUSINESS CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6522
Practice Address - Country:US
Practice Address - Phone:888-467-1117
Practice Address - Fax:888-485-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6613Medicaid
SC0281Medicare PIN