Provider Demographics
NPI:1497354617
Name:SOUTHCOAST MEDICAL SERVICES
Entity Type:Organization
Organization Name:SOUTHCOAST MEDICAL SERVICES
Other - Org Name:THE PERDIDO BAY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:205-292-2428
Mailing Address - Street 1:7094 FOREST MILL DR
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35453-1446
Mailing Address - Country:US
Mailing Address - Phone:205-292-2428
Mailing Address - Fax:205-462-3703
Practice Address - Street 1:34463 US HIGHWAY 98 STE G
Practice Address - Street 2:
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-4049
Practice Address - Country:US
Practice Address - Phone:251-961-0874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty