Organization
COASTAL CAROLINA HEART LLC
Active
Other names
WILMINGTON HEART CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY GUIDRY (CEO)
(704) 708-6610
Entity
Organization
Contact information
Practice address
1604 PHYSICIANS DR, SUITE 104, WILMINGTON, NC 28401-7362
(910) 762-2292
(910) 762-2208
Mailing address
10720 SIKES PL, SUITE 300, CHARLOTTE, NC 28277-8141
(704) 708-6610
(888) 401-6931
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016N9
BLUE CROSS BLUE SHIELD NC
NC
Enumeration date
04/01/2008
Last updated
04/08/2009
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