Provider Demographics
NPI:1811182546
Name:COASTAL CARDIOVASCULAR SURGEONS
Entity type:Organization
Organization Name:COASTAL CARDIOVASCULAR SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KESSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-9559
Mailing Address - Street 1:801 E 6TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3661
Mailing Address - Country:US
Mailing Address - Phone:850-785-9559
Mailing Address - Fax:850-785-7747
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-785-9559
Practice Address - Fax:850-785-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66264174400000X
FLME66118174400000X
FLME0049047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25247ZOtherMEDICARE PROVIDER NUMBER
FL32993COtherMEDICARE PROVIDER NUMBER
FL77694OtherMEDICARE GROUP PROVIDER
04997ZOtherMEDICARE PROVIDER NUMBER
FLF59536Medicare UPIN
FL32993COtherMEDICARE PROVIDER NUMBER
FL25247ZOtherMEDICARE PROVIDER NUMBER