Organization
COASTAL CAROLINA FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRIS A LANE (MEDICAL ADM)
(252) 426-5711
Entity
Organization
Contact information
Practice address
600 S CHURCH ST, HERTFORD, NC 27944-1205
(252) 426-5711
(252) 426-1999
Mailing address
PO BOX 650, HERTFORD, NC 27944-0650
(252) 426-5711
(252) 426-1999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40834
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222L
BCBS
NC
01
—
044647
TRIGON
—
05
—
890222L
—
NC
Enumeration date
08/24/2005
Last updated
07/09/2010
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