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Organization

COASTAL COMPLETE CARE, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAMIE PORTWOOD (BILLING MANAGER)
(850) 584-6000
Entity
Organization

Contact information

Practice address
100 PLANTATION RD, PERRY, FL 32348-6000
(850) 584-6000
Mailing address
100 PLANTATION RD, PERRY, FL 32348-6000
(850) 584-6000

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
FL
208D00000X
General Practice Physician
FL
332B00000X
Durable Medical Equipment & Medical Supplies

Other

Enumeration date
10/29/2014
Last updated
10/18/2018
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