Provider Demographics
NPI:1255458881
Name:MIDCOAST CARE INC. A MEDICAL GROUP
Entity type:Organization
Organization Name:MIDCOAST CARE INC. A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-709-3667
Mailing Address - Street 1:1570 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2261
Mailing Address - Country:US
Mailing Address - Phone:805-709-3667
Mailing Address - Fax:805-755-1196
Practice Address - Street 1:1570 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2261
Practice Address - Country:US
Practice Address - Phone:805-709-3667
Practice Address - Fax:805-755-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty