Provider Demographics
NPI:1689927626
Name:COASTAL NEUROLOGY AND NEUROSURGERY, INC
Entity Type:Organization
Organization Name:COASTAL NEUROLOGY AND NEUROSURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-562-4142
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5229
Mailing Address - Country:US
Mailing Address - Phone:907-562-4142
Mailing Address - Fax:907-631-4132
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5229
Practice Address - Country:US
Practice Address - Phone:907-562-4142
Practice Address - Fax:907-631-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK957948207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty