Provider Demographics
NPI:1629686613
Name:COASTAL FAMILY PRACTICE AND INTERNAL MEDICINE
Entity Type:Organization
Organization Name:COASTAL FAMILY PRACTICE AND INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:D
Authorized Official - Last Name:EICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-662-5964
Mailing Address - Street 1:1004 S OLD DIXIE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7200
Mailing Address - Country:US
Mailing Address - Phone:561-284-8383
Mailing Address - Fax:561-284-8380
Practice Address - Street 1:1004 S OLD DIXIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7200
Practice Address - Country:US
Practice Address - Phone:561-662-5964
Practice Address - Fax:561-284-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780772673OtherNPI NUMBER