Organization
COASTAL CAROLINA MEDICAL CENTER, INC
Active
Other names
Coastal Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
RON GROTELUSCHEN (CFO)
(843) 784-8076
Entity
Organization
Contact information
Practice address
10911 N JACOB SMART BLVD, D, RIDGELAND, SC 29936-2729
(843) 784-3101
(843) 784-5313
Mailing address
PO BOX 741261, ATLANTA, GA 30374-1261
(843) 784-3101
(843) 784-5313
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/16/2011
Last updated
03/22/2022
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