Provider Demographics
NPI:1790943017
Name:COASTAL FOOT CENTER
Entity Type:Organization
Organization Name:COASTAL FOOT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENTINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-938-6000
Mailing Address - Street 1:217 STATION ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6304
Mailing Address - Country:US
Mailing Address - Phone:910-938-6000
Mailing Address - Fax:910-938-3618
Practice Address - Street 1:217 STATION ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6304
Practice Address - Country:US
Practice Address - Phone:910-938-6000
Practice Address - Fax:910-938-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08055OtherBCBS PIN
NC8908055Medicaid
261QP1100XOtherMEDICARE NPI TYPE1
NC8908055Medicaid
08055OtherBCBS PIN