Organization
COASTAL CARDIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAVEL KHIMENKO MD (PRESIDENT)
(228) 202-3335
Entity
Organization
Contact information
Practice address
4211 HOSPITAL ST, SUITE 107, PASCAGOULA, MS 39581-5310
(228) 202-3335
(228) 202-3337
Mailing address
4211 HOSPITAL ST, SUITE 107, PASCAGOULA, MS 39581-5310
(228) 202-3335
(228) 202-3337
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
18035
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00571214
—
MS
01
—
422390786C
BCBS
MS
Enumeration date
12/11/2006
Last updated
01/17/2012
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