Provider Demographics
NPI:1639223886
Name:COASTAL FAMILY PRACTICE & ACUTE CARE CENTER LLC
Entity Type:Organization
Organization Name:COASTAL FAMILY PRACTICE & ACUTE CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-231-9286
Mailing Address - Street 1:9961 E COUNTY HIGHWAY 30A
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-7282
Mailing Address - Country:US
Mailing Address - Phone:850-231-9286
Mailing Address - Fax:850-231-9287
Practice Address - Street 1:9961 E COUNTY HIGHWAY 30A
Practice Address - Street 2:SUITE #5
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-7282
Practice Address - Country:US
Practice Address - Phone:850-231-9286
Practice Address - Fax:850-231-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care