Provider Demographics
NPI:1356444921
Name:COASTAL FAMILY HEALTH CENTER INC
Entity type:Organization
Organization Name:COASTAL FAMILY HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-374-2494
Mailing Address - Street 1:10467 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4634
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:228-374-2713
Practice Address - Street 1:300 SHOWS ST
Practice Address - Street 2:
Practice Address - City:MCLAIN
Practice Address - State:MS
Practice Address - Zip Code:39456
Practice Address - Country:US
Practice Address - Phone:601-753-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03330060Medicaid
MS03330060Medicaid