Provider Demographics
NPI:1336713890
Name:COASTAL SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:COASTAL SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:N.
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-969-9297
Mailing Address - Street 1:155 BORTHWICK AVENUE
Mailing Address - Street 2:SUITE 200 E
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:561-330-3381
Mailing Address - Fax:561-330-3382
Practice Address - Street 1:291 SHATTUCK WAY
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:561-330-3381
Practice Address - Fax:561-330-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical