Provider Demographics
NPI:1609910603
Name:US COAST GUARD
Entity Type:Organization
Organization Name:US COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HSC
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:CHIEF HEALTH SERVICE
Authorized Official - Phone:202-372-4102
Mailing Address - Street 1:4807 KING JOHN WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4807 KING JOHN WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5983
Practice Address - Country:US
Practice Address - Phone:202-372-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service