# COASTAL CHRONIC PAIN SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GULFPORT ANESTHESIA SERVICES, P.A.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134214331
- **Legal business name:** GULFPORT ANESTHESIA SERVICES, P.A.
- **Authorized official:** DIANE SCHULTZ (DIRECTOR)
- **Authorized official phone:** (228) 831-0204

## Contact information

- **Practice address:** 15190 COMMUNITY RD STE 230B, GULFPORT, MS 39503-3483
- **Practice address phone:** (228) 831-0050
- **Practice address fax:** (228) 831-1121
- **Mailing address:** 15190 COMMUNITY RD STE 230B, GULFPORT, MS 39503-3483
- **Mailing address phone:** (228) 831-0050
- **Mailing address fax:** (228) 831-1121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 11/09/2018