Provider Demographics
NPI:1861813479
Name:COAST TO COAST HEALTHCARE INCORPORATED
Entity Type:Organization
Organization Name:COAST TO COAST HEALTHCARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-855-9961
Mailing Address - Street 1:5195 HAMPSTED VILLAGE CENTER WAY STE 256
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8331
Mailing Address - Country:US
Mailing Address - Phone:614-855-9961
Mailing Address - Fax:801-214-1946
Practice Address - Street 1:5195 HAMPSTED VILLAGE CENTER WAY STE 256
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8331
Practice Address - Country:US
Practice Address - Phone:614-855-9961
Practice Address - Fax:801-214-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty