Provider Demographics
NPI:1720014012
Name:COASTAL GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:COASTAL GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LOVING
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-754-7790
Mailing Address - Street 1:3 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462
Mailing Address - Country:US
Mailing Address - Phone:910-754-7790
Mailing Address - Fax:910-754-7838
Practice Address - Street 1:3 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462
Practice Address - Country:US
Practice Address - Phone:910-754-7790
Practice Address - Fax:910-754-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891235GMedicaid
NC1235GOtherBLUE SHIELD
NC1235GOtherBLUE SHIELD
B08266Medicare UPIN