Provider Demographics
NPI:1891044053
Name:COAST UROLOGY SERVICES INC.
Entity Type:Organization
Organization Name:COAST UROLOGY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-786-2500
Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7386
Mailing Address - Country:US
Mailing Address - Phone:586-498-9440
Mailing Address - Fax:586-498-9460
Practice Address - Street 1:35 CASA ST
Practice Address - Street 2:SUITE 370
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1818
Practice Address - Country:US
Practice Address - Phone:586-498-9440
Practice Address - Fax:586-498-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical