Provider Demographics
NPI:1356198857
Name:COASTAL PAIN & SPINE CENTER LLC
Entity type:Organization
Organization Name:COASTAL PAIN & SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-283-9306
Mailing Address - Street 1:38 SHERIDAN PARK CIR STE F
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7023
Mailing Address - Country:US
Mailing Address - Phone:843-757-6744
Mailing Address - Fax:866-502-2928
Practice Address - Street 1:38 SHERIDAN PARK CIR STE F
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7023
Practice Address - Country:US
Practice Address - Phone:843-757-6744
Practice Address - Fax:866-502-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty