# COASTAL CAROLINA ENT DO PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689757007
- **Authorized official:** MRS. WENDY COTRINA PARIS CPC (INSURANCE BILLING MGR)
- **Authorized official phone:** (910) 914-0540

## Contact information

- **Practice address:** 302 LIBERTY ST, WHITEVILLE, NC 28472-3714
- **Practice address phone:** (910) 914-0540
- **Practice address fax:** (910) 914-0640
- **Mailing address:** 302 LIBERTY ST, WHITEVILLE, NC 28472-3714
- **Mailing address phone:** (910) 914-0540
- **Mailing address fax:** (910) 914-0640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 85930 | NC | Yes |

## Other

- **Enumeration date:** 10/21/2006
- **Last updated:** 06/17/2024