Provider Demographics
NPI:1497230171
Name:COASTAL FOOT & ANKLE INC
Entity Type:Organization
Organization Name:COASTAL FOOT & ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-258-1717
Mailing Address - Street 1:300 HANOVER ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5451
Mailing Address - Country:US
Mailing Address - Phone:508-258-1717
Mailing Address - Fax:774-365-6272
Practice Address - Street 1:300 HANOVER ST STE 2C
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5451
Practice Address - Country:US
Practice Address - Phone:508-258-1717
Practice Address - Fax:774-365-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty