Provider Demographics
NPI:1740057017
Name:COASTAL MEDICAL AND WELLNESS PLLC
Entity type:Organization
Organization Name:COASTAL MEDICAL AND WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURBER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:252-647-1616
Mailing Address - Street 1:1537 FREEDOM WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-3647
Mailing Address - Country:US
Mailing Address - Phone:910-238-4268
Mailing Address - Fax:910-238-4397
Practice Address - Street 1:1537 FREEDOM WAY STE 2
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-3647
Practice Address - Country:US
Practice Address - Phone:910-238-4268
Practice Address - Fax:910-238-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty