Provider Demographics
NPI:1467635128
Name:COASTAL HEALTHCARE RESOURCES INC
Entity Type:Organization
Organization Name:COASTAL HEALTHCARE RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:866-877-2762
Mailing Address - Street 1:PO BOX 6467
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-6467
Mailing Address - Country:US
Mailing Address - Phone:866-877-2762
Mailing Address - Fax:
Practice Address - Street 1:1807 W EVANS ST STE C
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3374
Practice Address - Country:US
Practice Address - Phone:866-877-2762
Practice Address - Fax:866-992-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty