Provider Demographics
NPI:1750688339
Name:COASTAL HEALTH CENTER
Entity Type:Organization
Organization Name:COASTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-667-2422
Mailing Address - Street 1:37 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3383
Mailing Address - Country:US
Mailing Address - Phone:207-667-2422
Mailing Address - Fax:207-667-0135
Practice Address - Street 1:37 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3383
Practice Address - Country:US
Practice Address - Phone:207-667-2422
Practice Address - Fax:207-667-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124610000Medicaid
ME1538140520Medicare NSC
MM4393Medicare PIN