Provider Demographics
NPI:1740389170
Name:COASTAL RADIOLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:COASTAL RADIOLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACBR
Authorized Official - Phone:919-562-6570
Mailing Address - Street 1:851 A DURHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-562-6570
Mailing Address - Fax:
Practice Address - Street 1:851 DURHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-562-6570
Practice Address - Fax:919-562-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2160111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908817Medicaid
NCU70339Medicare UPIN
NC2449755AMedicare ID - Type Unspecified