Organization
COASTAL FAMILY HEALTH CENTER, INC
Active
Other names
Coastal Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANGELIQUE S GREER (CEO)
(228) 374-2494
Entity
Organization
Contact information
Practice address
109 HOSPITAL DR, BAY ST LOUIS, MS 39520-1604
(228) 463-9666
(228) 374-0856
Mailing address
10467 CORPORATE DR, GULFPORT, MS 39503-4634
(228) 374-2494
(228) 396-3457
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9014820
—
MS
01
—
C00895
MEDICARE/CAHABA
MS
Enumeration date
10/12/2005
Last updated
08/16/2024
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