Provider Demographics
NPI:1619987096
Name:COASTAL GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:COASTAL GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-342-2299
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1648
Mailing Address - Country:US
Mailing Address - Phone:843-342-2299
Mailing Address - Fax:843-342-2189
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1648
Practice Address - Country:US
Practice Address - Phone:843-342-2299
Practice Address - Fax:843-342-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22876207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4537Medicaid
SCGP4537Medicaid