Provider Demographics
NPI:1578578290
Name:COASTAL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:COASTAL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAWSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-818-2766
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533
Mailing Address - Country:US
Mailing Address - Phone:228-818-2766
Mailing Address - Fax:228-818-2394
Practice Address - Street 1:COASTAL FAMILY HEALTH CENTER
Practice Address - Street 2:5052 STE A
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560
Practice Address - Country:US
Practice Address - Phone:228-864-4818
Practice Address - Fax:228-864-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)