Provider Demographics
NPI:1699850230
Name:COASTAL OCCUPATIONAL MEDICINE AND PAIN MANAGEMENT, P.C.
Entity Type:Organization
Organization Name:COASTAL OCCUPATIONAL MEDICINE AND PAIN MANAGEMENT, P.C.
Other - Org Name:COASTAL HEALTH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:251-943-5440
Mailing Address - Street 1:PO BOX 1862
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-1862
Mailing Address - Country:US
Mailing Address - Phone:251-943-5440
Mailing Address - Fax:251-943-5404
Practice Address - Street 1:915 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1324
Practice Address - Country:US
Practice Address - Phone:251-943-5440
Practice Address - Fax:251-943-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDE1469OtherMEDICARE RAILROAD
AL529921150Medicaid
AL6144060001Medicare NSC
AL529921150Medicaid