Organization
COASTAL STATES MANAGEMEN
Active
Other names
southeastern pain managment
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KATHERINE JACOBS (CHIEF OPERATING OFFICER)
(256) 492-7246
Entity
Organization
Contact information
Practice address
1026 GOODYEAR AVE, BLDG 400, STE 302, GADSDEN, AL 35903-1102
(256) 492-7246
(256) 492-1168
Mailing address
1026 GOODYEAR AVE, BLDG 400, STE 302, GADSDEN, AL 35903-1102
(256) 492-7246
(256) 492-1168
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1294
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05152215RAY
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/03/2006
Last updated
08/22/2020
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