Organization
COASTAL PHYSICAL MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA MCSWAIN (PRACTICE MANAGER)
(843) 762-2274
Entity
Organization
Contact information
Practice address
3185 AZALEA DR, NORTH CHARLESTON, SC 29405-8211
(843) 762-2274
(843) 762-2278
Mailing address
PO BOX 12819, CHARLESTON, SC 29422-2819
(843) 762-2274
(843) 762-2278
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
19612
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2989
—
SC
Enumeration date
02/27/2008
Last updated
02/27/2008
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