Provider Demographics
NPI:1508530635
Name:COASTAL SPINE INSTITUTE PC
Entity Type:Organization
Organization Name:COASTAL SPINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-459-5890
Mailing Address - Street 1:509 OLDE WATERFORD WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4126
Mailing Address - Country:US
Mailing Address - Phone:910-356-6100
Mailing Address - Fax:
Practice Address - Street 1:509 OLDE WATERFORD WAY STE 204
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4126
Practice Address - Country:US
Practice Address - Phone:910-356-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty