Provider Demographics
NPI:1659359131
Name:U. S. COAST GUARD
Entity Type:Organization
Organization Name:U. S. COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PATTERSON
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:II
Authorized Official - Credentials:PREVENTIVE MED TECH
Authorized Official - Phone:757-483-8597
Mailing Address - Street 1:4000 COAST GUARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2135
Mailing Address - Country:US
Mailing Address - Phone:757-483-8597
Mailing Address - Fax:757-483-8610
Practice Address - Street 1:4000 COAST GUARD BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2135
Practice Address - Country:US
Practice Address - Phone:757-483-8597
Practice Address - Fax:757-483-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization