Provider Demographics
NPI:1659451029
Name:COASTAL UROLOGICAL PARTNERS, LLC
Entity Type:Organization
Organization Name:COASTAL UROLOGICAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/INSURANCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-920-0055
Mailing Address - Street 1:11706 MERCY BLVD
Mailing Address - Street 2:PLAZA A, SUITE 10
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1751
Mailing Address - Country:US
Mailing Address - Phone:912-920-0055
Mailing Address - Fax:912-920-3367
Practice Address - Street 1:11706 MERCY BLVD
Practice Address - Street 2:PLAZA A, SUITE 10
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1751
Practice Address - Country:US
Practice Address - Phone:912-920-0055
Practice Address - Fax:912-920-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty