Provider Demographics
NPI:1619062015
Name:US COAST GUARD
Entity Type:Organization
Organization Name:US COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HS2
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HERSHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH SERVICES TECH
Authorized Official - Phone:609-898-6291
Mailing Address - Street 1:1 MUNRO AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-5000
Mailing Address - Country:US
Mailing Address - Phone:609-898-6610
Mailing Address - Fax:609-898-6962
Practice Address - Street 1:1 MUNRO AVE
Practice Address - Street 2:
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6610
Practice Address - Fax:609-898-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC24720000X261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care