Provider Demographics
NPI:1922109701
Name:COASTAL ORTHOPEDIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:COASTAL ORTHOPEDIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-234-7857
Mailing Address - Street 1:2376 CYPRESS CIRCLE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8920
Mailing Address - Country:US
Mailing Address - Phone:843-347-7222
Mailing Address - Fax:843-347-3305
Practice Address - Street 1:2376 CYPRESS CIRCLE
Practice Address - Street 2:SUITE 300
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8920
Practice Address - Country:US
Practice Address - Phone:843-347-7222
Practice Address - Fax:843-347-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0418OtherDME MEDICAID
SC0313730001OtherDME MEDICARE
SC42D0675833OtherCLIA
SCPA7162Medicaid
SCP66304Medicare UPIN
SC42D0675833OtherCLIA
SCD79057Medicare UPIN
SCS78392Medicare UPIN
SCG98706Medicare UPIN
SCS621123850Medicare UPIN
SCG28686Medicare UPIN
SC3850Medicare ID - Type Unspecified
SCDM0418OtherDME MEDICAID
SCC60606Medicare UPIN
SCE59804Medicare UPIN
SC0313730001OtherDME MEDICARE